title: Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study.
abstract: OBJECTIVE
  To use office gel sonovaginography (SVG) to predict posterior deep infiltrating endometriosis (DIE) in women undergoing laparoscopy.
  
  
  METHODS
  This was a multicenter prospective observational study carried out between January 2009 and February 2013. All women were of reproductive age, had a history of chronic pelvic pain and underwent office gel SVG assessment for the prediction of posterior compartment DIE prior to laparoscopic endometriosis surgery. Gel SVG findings were compared with laparoscopic findings to determine the diagnostic accuracy of office gel SVG for the prediction of posterior compartment DIE.
  
  
  RESULTS
  In total, 189 women underwent preoperative gel SVG and laparoscopy for endometriosis. At laparoscopy, 57 (30%) women had posterior DIE and 43 (23%) had rectosigmoid/anterior rectal DIE. For the prediction of rectosigmoid/anterior rectal (i.e. bowel) DIE, gel SVG had an accuracy of 92%, sensitivity of 88%, specificity of 93%, positive predictive value (PPV) of 79%, negative predictive value (NPV) of 97%, positive likelihood ratio (LR+) of 12.9 and negative likelihood ratio (LR-) of 0.12 (P = 3.98E-25); for posterior vaginal wall and rectovaginal septum (RVS) DIE, respectively, the accuracy was 95% and 95%, sensitivity was 18% and 18%, specificity was 99% and 100%, PPV was 67% and 100%, NPV was 95% and 95%, LR+ was 32.4 and infinity and LR- was 0.82 and 0.82 (P = 0.009 and P = 0.003).
  
  
  CONCLUSIONS
  Office gel SVG appears to be an effective outpatient imaging technique for the prediction of bowel DIE, with a higher accuracy for the prediction of rectosigmoid compared with anterior rectal DIE. Although the sensitivity for vaginal and RVS DIE was limited, gel SVG had a high specificity and NPV for all forms of posterior DIE, indicating that a negative gel SVG examination is highly suggestive of the absence of DIE at laparoscopy.
authors.affiliation: Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Penrith, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Reid
authors.forename: C
authors.initials: C
authors.lastname: Lu
authors.forename: N
authors.initials: N
authors.lastname: Hardy
authors.forename: I
authors.initials: I
authors.lastname: Casikar
authors.forename: G
authors.initials: G
authors.lastname: Reid
authors.forename: G
authors.initials: G
authors.lastname: Cario
authors.forename: D
authors.initials: D
authors.lastname: Chou
authors.forename: D
authors.initials: D
authors.lastname: Almashat
authors.forename: G
authors.initials: G
authors.lastname: Condous
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012002:Rectal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D012680:Sensitivity and Specificity; D012810:Sigmoid Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D014463:Ultrasonography; D014621:Vagina / Q000000981:diagnostic imaging*
keywords: DIE; SVG; laparoscopy; office gel sonovaginography; posterior deep infiltrating endometriosis; sliding sign