title: Endovaginal ultrasound-assisted pain mapping in endometriosis and chronic pelvic pain.
abstract: The objective of this study was to determine if the combination of tenderness-guided endovaginal ultrasound and digital pelvic exam (i.e. EVUS-assisted exam) for preoperative pain mapping, in cases without nodules or endometriomas, increases sensitivity/specificity for laparoscopic findings. This was a retrospective review of women with chronic pelvic pain ± infertility with preoperative pain mapping exam prior to laparoscopy (n = 97, 2006-7). Predictor variables (EVUS-assisted exam vs digital pelvic exam alone, for pain mapping) were coded as tender vs non-tender. Primary outcome was findings on laparoscopy (e.g. endometriosis or adhesions) and was coded as abnormal vs normal. We found that EVUS-assisted exam had greater sensitivity (0.81, 95% CI: 0.70-0.89) for abnormal laparoscopy compared with digital pelvic exam alone (0.58, 95% CI: 0.46-0.69) (McNemar's test, p < 0.001). Specificity was limited for both types of pain mapping (0.22, 95% CI: 0.08-0.44 for EVUS-assisted; and 0.39, 95% CI: 0.20-0.61 for digital), with no significant difference (p = 0.13). In conclusion, in the absence of nodules or endometriomas, EVUS-assisted exam increases sensitivity, but with no benefit in specificity, for prediction of abnormal laparoscopy.
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Yong
authors.forename: C
authors.initials: C
authors.lastname: Sutton
authors.forename: M
authors.initials: M
authors.lastname: Suen
authors.forename: C
authors.initials: C
authors.lastname: Williams
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000000981:diagnostic imaging / Q000601:surgery; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D058869:Gynecological Examination / Q000379:methods*; D006801:Humans; D007247:Infertility, Female / Q000000981:diagnostic imaging* / Q000601:surgery; D010535:Laparoscopy; D017699:Pelvic Pain / Q000000981:diagnostic imaging* / Q000601:surgery; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D055815:Young Adult