Extended transvaginal sonography in deep infiltrating endometriosis: use of bowel preparation and an acoustic window with intravaginal gel: preliminary results.
OBJECTIVE
The purpose of this study was to assess the diagnostic performance of extended transvaginal sonography for diagnosing deep infiltrating endometriosis.


METHODS
A prospective study was conducted comprising 51 women (mean age, 32.9 years; range, 23-43 years) with suspected deep infiltrating endometriosis based on clinical symptoms. All women underwent extended transvaginal sonography, which included assessment of 2 pelvic compartments (anterior compartment: bladder and distal ureters; and posterior compartment: posterior vaginal fornix, retrocervical area, pouch of Douglas, and rectosigmoid). The sliding sign for detecting pouch of Douglas obliteration was also assessed. All patients received bowel preparation before sonographic examinations. A single examiner performed all examinations. All women underwent laparoscopic surgery, and histologic confirmation of endometriosis was done. The sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated.


RESULTS
Some women had more than 1 lesion, giving a total of 55 histologically confirmed lesions (rectosigmoid, n = 13; vagina, n = 5; retrocervical, n = 32; bladder, n = 5). The sensitivity, specificity, and LR+ for rectosigmoid involvement were 100%, 93%, and 14.0, respectively. The sensitivity, specificity, LR+, and LR- for vaginal involvement were 60%, 98%, 30.0, and 0.41. The sensitivity, specificity, LR+, and LR- for retrocervical involvement were 84%, 96%, 19.4, and 0.16. The sensitivity, specificity, and LR- for bladder involvement were 20%, 100%, and 0.80. The sensitivity, specificity, LR+, and LR- of the sliding sign for diagnosing pouch of Douglas obliteration were 89%, 92%, 10.7, and 0.12.


CONCLUSIONS
Except for bladder involvement, extended transvaginal sonography has good diagnostic performance for deep infiltrating endometriosis.
Department of Obstetrics and Gynecology, Medical School, Clinica Universidad de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain. jalcazar@unav.es.
Mauricio
M
León
Humberto
H
Vaccaro
Juan Luis
JL
Alcázar
Jaime
J
Martinez
Jorge
J
Gutierrez
Fernando
F
Amor
Alberto
A
Iturra
Hugo
H
Sovino
D000328:Adult; D004715:Endometriosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007410:Intestinal Diseases / Q000000981:diagnostic imaging*; D054368:Laxatives; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*; D001745:Urinary Bladder Diseases / Q000000981:diagnostic imaging*; D014622:Vaginal Creams, Foams, and Jellies; D014623:Vaginal Diseases / Q000000981:diagnostic imaging*; D055815:Young Adult
D054368:Laxatives; D014622:Vaginal Creams, Foams, and Jellies
deep infiltrating endometriosis; diagnosis; gynecologic ultrasound; sonography