Prediction of endometriosis by transvaginal ultrasound in reproductive-age women with normal ovarian size

Objective: To predict endometriosis by transvaginal ultrasound (TVS) in reproductive-age women with normal ovarian size.Design: Prospective study.Setting: El-Shatby Maternity Hospital, Alexandria University.Patients: 125 Women with symptoms suggestive of endometriosis and with normal ovarian size during TVS.Interventions: Patients were subjected to high frequency ultrasound and evaluated for the presence of ultrasound signs of endometriosis (TVS-based soft markers). All patients had laparoscopy (gold standard) immediately after TVS for documentation of the presence of endometriosis.Main outcome measures: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of TVS and of the TVS-based soft markers in diagnosing endometriosis.Results: Endometriosis was confirmed laparoscopicaly in 68/125 patients (54.4%). The sensitivity, specificity, PPV, NPV and diagnostic accuracy of TVS in diagnosing endometriosis were 85.3%, 80.7%, 84.1%, 82.1% and 83.2%, respectively. Six TVS-based soft markers showed significant association (P < 0.05) with endometriosis (ovaries not at the same level, high left ovary, ovarian fixation to uterus, tender ultrasound, ovarian fixation to iliac vessels and non visualization of left ovary) with sensitivities of 85.3%, 80.9%, 80.9%, 66.2%, 55.9% and 55.9%, respectively. These markers could be considered as positive soft markers to predict endometriosis. The addition of these soft markers could improve the sensitivity, specificity, PPV, NPV and diagnostic accuracy to 97.3%, 98.5%, 95.7%, 89.9% and 91.2%, respectively.Conclusion: TVS appears to be a useful imaging method for the prediction of endometriosis. The inclusion of TVS-based positive soft markers either alone or in combination improves our ability to predict endometriosis