title: Diagnostic value of transvaginal 'tenderness-guided' ultrasonography for the prediction of location of deep endometriosis.
abstract: BACKGROUND
  The aim was to evaluate the diagnostic accuracy of transvaginal tenderness-guided ultrasonography in the identification of location of deep endometriosis.
  
  
  METHODS
  Consecutive women scheduled for surgery in our Department for clinically suspected endometriosis were included in this prospective study. All women underwent modified transvaginal ultrasonography using a stand-off in the week before surgery, which also evaluated the painful sites evocated by a gentle pressure of the probe. Five locations of deep endometriosis were considered: vaginal walls, rectovaginal septum, rectosigmoid involvement, uterosacral ligaments and anterior compartment (anterior pouch and/or bladder). Sensitivity, specificity and likelihood ratios (LR+/-) were calculated with 95% confidence intervals (CIs).
  
  
  RESULTS
  We included 88 women; surgery associated with histopathological evaluation revealed deep endometriosis in different pelvic locations in 72 patients. With respect to the vaginal walls, transvaginal ultrasonography had a sensitivity of 91% (95% CI, 79-97%), specificity of 89% (95% CI, 81-93%), an LR+ of 8.2 and an LR- of 0.09. For endometriosis of rectovaginal septum, transvaginal ultrasonography had a sensitivity of 74% (95% CI, 64-80%), specificity of 88% (95% CI, 4-8%), an LR+ of 6.2 and an LR- of 0.3. For other locations, the sensitivity was lower (ranging from 67% to 33%) with a comparable specificity.
  
  
  CONCLUSIONS
  This technique shows a high specificity and sensitivity in the detection of vaginal and rectovaginal endometriosis. Good specificity associated with a lower sensitivity was obtained in the diagnosis of deep endometriosis of uterosacral ligaments, rectosigmoid involvement or anterior deep endometriosis.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Cagliari, Ospedale San Giovanni di Dio, 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: Bruna
authors.initials: B
authors.lastname: Virgilio
authors.forename: Stefano
authors.initials: S
authors.lastname: Angioni
authors.forename: Gian Benedetto
authors.initials: GB
authors.lastname: Melis
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005831:Genital Diseases, Female / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D017699:Pelvic Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors; D014110:Touch; D018615:Ultrasonography, Doppler, Color / Q000379:methods*