"Tenderness-guided" transvaginal ultrasonography: a new method for the detection of deep endometriosis in patients with chronic pelvic pain.
OBJECTIVE
To determine the accuracy of transvaginal ultrasonography (TVUS) using a modified "tenderness-guided" approach in the diagnosis of deep endometriosis of the cul-de-sac, retrocervical region, and rectovaginal septum.


METHODS
Prospective study.


METHODS
Academic department of obstetrics and gynecology.


METHODS
Fifty women scheduled for laparoscopy for chronic pelvic pain.


METHODS
All patients underwent TVUS. The modified tenderness-guided approach consisted of TVUS combined with the introduction of 12 mL of ultrasound transmission gel (instead of the usual 4 mL) in the probe cover to create a stand-off to visualize the near-field area. The posterior fornix was evaluated accurately with an up-and-down sliding movement of the probe. In addition, when the patient indicated that tenderness was evoked by the probe's pressure, the sliding movement was stopped, and particular attention was paid to the painful site for detection of endometriosis lesions.


METHODS
Sensitivity, specificity, and kappa values.


RESULTS
Using this approach, we obtained a specificity of 95% with a sensitivity of 90%, associated with a very high kappa value of 0.86 (95% CI, 0.56-0.91).


CONCLUSIONS
Our new TVUS approach appears to be an accurate, inexpensive, and less invasive method for the diagnosis of deep endometriosis.
Guerriero
Stefano
S
Department of Obstetrics and Gynaecology, University of Cagliari, Cagliari, Italy. gineca.sguerriero@tiscali.it
Ajossa
Silvia
S
Gerada
Marta
M
D'Aquila
Marina
M
Piras
Bruno
B
Melis
Gian Benedetto
GB
D000328:Adult; D002908:Chronic Disease; D004715:Endometriosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D010147:Pain Measurement / Q000379:methods; D017699:Pelvic Pain / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D014110:Touch; D014463:Ultrasonography; D014621:Vagina / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery