Transvaginal ultrasound for the diagnosis of endometriosis in the uterosacral ligaments, torus uterinus and posterior vaginal fornix: a prospective study.

OBJECTIVES Evaluate the diagnostic accuracy of transvaginal sonography (TVS) in predicting the presence of deep endometriosis (DE) in the uterosacral ligaments (USLs), torus uterinus (TU) and posterior vaginal fornix (PVF) in women with suspected endometriosis scheduled for laparoscopic surgery. Additionally, we assessed the association of DE in other pelvic locations and correlated symptoms with the presence of DE in the USLs, TU and PVF. METHODS Consecutive women with clinically suspected or proven pelvic endometriosis scheduled for laparoscopic surgery were invited to participate in the study. TVS was performed before surgery. TVS findings were compared with those obtained by laparoscopy and confirmed histologically, and symptoms and associations correlated with other forms of endometriosis were analyzed. RESULTS 172 patients were studied. The global sensitivity and specificity of TVS were 91% and 87% for diagnosing DE in the USLs, TU or PVF. The accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of TVS diagnosis of DE in the USLs were 89.5%, 96.6%, 82.1%, 85%, 95.8%, 5.4 and 0.04 respectively; 86.6%, 83.9%, 89.4%, 89%, 84.4%, 7.9 and 0.18, respectively in the TU; and 93.6%, 86.9%, 94.6%, 71.4%, 97.9%, 16.09 and 0.14, respectively in the PVF. Logistic regression analysis showed a significant association between DE in USL/TU/PVF and DE in the rectosigmoid (OR: 5.43, p<0.001). CONCLUSIONS TVS has a high accuracy, sensitivity, specificity, PPV, NPV, LR+ and LH- for the assessment of DE in the USLs, TU and PVF. This article is protected by copyright. All rights reserved.