title: Routine vs. expert-guided transvaginal ultrasound in the diagnosis of endometriosis: a retrospective review.
abstract: OBJECTIVE
  The objective of this study is to evaluate the sensitivity of routine trans vaginal ultrasound (TVUS) compared to expert-guided transvaginal ultrasound (ETVUS) for the diagnosis of endometriosis.
  
  
  METHODS
  A retrospective chart review performed at a Canadian tertiary center specializing in the diagnosis and management of endometriosis. All cases with surgically confirmed endometriosis and an ETVUS completed at a single center were included for review and compared to routine TVUS performed for the same indication.
  
  
  RESULTS
  Forty cases met the inclusion criteria. Mean patient age of the study population at first surgical diagnosis was 31.2 ± 6.9 years. Dysmenorrhea (76.9 %) and chronic pelvic pain (74.3 %) were the most common presenting symptoms. Sensitivity of routine TVUS was 25 % (10/40), compared to 78 % (31/40) with ETVUS, (P < 0.01). Comparisons were made based on site of disease. Routine TVUS and ETVUS detected bladder involvement in (0/40) vs. 5 % (2/40); ureter (0/40) vs. 7.5 % (3/40); ovary 25 % (10/40) vs. 72.5 % (29/40); retrocervical area (0/40) vs. 60 % (24/40), rectosigmoid 5 % (2/40) vs. 77.5 % (31/40), respectively. Specific endometriotic lesions recognized by TVUS versus ETVUS, were: ovarian endometriomas in 25 % (10/40) vs. 45 % (18/40), adhesions leading to abnormal anatomy in 2.5 % (1/40) vs. 77.5 % (31/40); endometriotic implants or plaques in 2.5 % (1/40) vs. 70 % (28/40); and endometriotic nodules in 2.5 % (1/40) vs. 35 % (14/40), respectively. Routine TVUS diagnosis relied on the presence or absence of endometrioma (10/10), whereas ETVUS showed additional sites of disease in 97 % (30/31) patients.
  
  
  CONCLUSIONS
  ETVUS is more sensitive than routine TVUS to diagnose endometriosis, identifying lesions other than endometrioma and is of assistance in surgical planning and patient counseling.
authors.affiliation: Department of Medical Imaging, University of Ottawa, 501, Smyth Road, Ottawa, ON, K1H8L6, Canada, margfraser@toh.on.ca.
authors.forename: Margaret Ann
authors.initials: MA
authors.lastname: Fraser
authors.forename: Sugandha
authors.initials: S
authors.lastname: Agarwal
authors.forename: Innie
authors.initials: I
authors.lastname: Chen
authors.forename: Sukhbir Sony
authors.initials: SS
authors.lastname: Singh
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004715:Endometriosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods; D014621:Vagina; D055815:Young Adult