Monday, December 24, 2007
The role of ultrasonography in the diagnosis of endometriosis
OBJECTIVE: to evaluate transvaginal ultrasound scanning as a diagnostic test for the accurate diagnosis of pelvic endometriosis . METHODS: This study was carried out on 250 women during the period from March 2003 through March 2005 .All patients had laparoscopy for infertility and/or chronic pelvic pain. Biopsies were performed on all suspected lesions when possible for histological examination. They underwent TVS within one week before laparoscopy . Ovarian endometriosis has been distinguished from non-ovarian endometriosis involving other pelvic organs. The sensitivity, specificity, predictive values and accuracy of TVS for predicting pelvic endometriosis were assessed. RESULTS: The sensitivity, specificity, PPV, NPV & diagnostic accuracy of TVS for the diagnosis of all pelvic endometriosis were 83.3, 92.2, 86.9, 89.8 and 88.8 % respectively . The sensitivity, specificity, PPV, NPV and diagnostic accuracy of TVS for the diagnosis of ovarian Endometriosis were 96.6, 99.5, 96.6, 99.5 and 99.2% respectively . The sensitivity, specificity, PPV, NPV and diagnostic accuracy of TVS for the diagnosis of nonovarian endometriosis were 77.2, 94.1, 82.2, 92.1, and 89.6 % respectively. The sensitivity, specificity and diagnostic accuracy of TVS for the diagnosis of endometriosis by detection of Thickening of the uterosacral ligaments , mass or nodule in douglas pouch , mass in rectovaginal space , fixed RVF uterus , free blood in douglas pouch , douglas pouch oblitration , mass or nodule in uterovesical pouch and adenomyosis were 75, 91.3 and 86.3 % ; 66.6 , 89.5 and 83.3 % ; 66.6, 96.6 and 93.9 % ; 63.6 , 92.7 and 87.8 % ; 54.5, 85.4 and 80.3 % ; 63.6, 89 and 84.8 %; 36.3, 89 and 80.3 %; 75, 75 and 75 % respectively . CONCLUSION: TVS accurately diagnoses ovarian endometriosis but is less accurate for the diagnosis of nonovarian endometriosis .Also , we found that TVS has a better accuracy in diagnosing rectovaginal septum involvement and uterosacral endometriosis than uterovesical pouch and douglas pouch endometriosis .