Correlation of Sonographic and Intraoperative Findings of Deep-Infiltrating Endometriosis

Endometriosis is a chronic inflammatory condition affecting approximately 5%-10% of reproductive-aged women. Transvaginal ultrasound (TVUS) is increasingly used to diagnose deep-infiltrating endometriosis (DIE). This study assesses the sonographic accuracy of detecting intraoperative DIE lesions after implementing a structured protocol and its ability to predict the need for advanced laparoscopic procedures in patients undergoing excisional endometriosis surgery.

An IRB-exempt retrospective study was conducted over a 12-month period at a tertiary-level academic hospital. Inclusion criteria included women >18 years old who underwent a laparoscopic excision of endometriosis with or without hysterectomy and had a preoperative office TVUS performed based on the International Deep Endometriosis Analysis consensus within 6 months of surgery. Demographic data, endometriosis history, sonographic, operative, and pathology reports were collected. Appropriate statistical tests were applied.

Of 117 patients, 89 women met inclusion criteria. Endometriosis pathology was confirmed in 90% of patients. TVUS had a sensitivity of 61% (95% confidence interval [CI]: 49-72), specificity of 94% (95% CI: 71-100), negative predictive value of 36% (95% CI: 22-52), positive predictive value of 98% (95% CI: 88-100), and odds ratio (OR) of 24.4 (95% CI: 3.4-1071; P < .001). Negative sliding sign (OR 7.12, P = .006) and rectovaginal space abnormality (OR 19.9, P = .002) were associated with intraoperative DIE and advanced laparoscopic procedures, including enterolysis or adhesiolysis >30 minutes (OR 11.3, P < .001) and ureterolysis (OR 3.29, P = .013).

Sonographic markers, particularly sliding sign and posterior compartment abnormalities, can predict intraoperative DIE and the need for complex laparoscopic procedures. TVUS may aid in surgical planning and improve patient counseling and outcomes.