"Tenderness-guided" transvaginal ultrasonography: a new method for the detection of deep endometriosis in patients with chronic pelvic pain

OBJECTIVE: To determine the accuracy of transvaginal ultrasonography (TVUS) using a modified "tenderness-guided" approach in the diagnosis of deep endometriosis of the cul-de-sac, retrocervical region, and rectovaginal septum. DESIGN: Prospective study. SETTING: Academic department of obstetrics and gynecology. PATIENT(S): Fifty women scheduled for laparoscopy for chronic pelvic pain. INTERVENTION(S): All patients underwent TVUS. The modified tenderness-guided approach consisted of TVUS combined with the introduction of 12 mL of ultrasound transmission gel (instead of the usual 4 mL) in the probe cover to create a stand-off to visualize the near-field area. The posterior fornix was evaluated accurately with an up-and-down sliding movement of the probe. In addition, when the patient indicated that tenderness was evoked by the probe's pressure, the sliding movement was stopped, and particular attention was paid to the painful site for detection of endometriosis lesions. MAIN OUTCOME MEASURE(S): Sensitivity, specificity, and kappa values. RESULT(S): Using this approach, we obtained a specificity of 95% with a sensitivity of 90%, associated with a very high kappa value of 0.86 (95% CI, 0.56-0.91). CONCLUSION(S): Our new TVUS approach appears to be an accurate, inexpensive, and less invasive method for the diagnosis of deep endometriosis