title: "Tenderness-guided" transvaginal ultrasonography: a new method for the detection of deep endometriosis in patients with chronic pelvic pain.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Cagliari, Cagliari, Italy. gineca.sguerriero@tiscali.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Guerriero
authors.forename: Silvia
authors.initials: S
authors.lastname: Ajossa
authors.forename: Marta
authors.initials: M
authors.lastname: Gerada
authors.forename: Marina
authors.initials: M
authors.lastname: D'Aquila
authors.forename: Bruno
authors.initials: B
authors.lastname: Piras
authors.forename: Gian Benedetto
authors.initials: GB
authors.lastname: Melis
mesh_terms: 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