Objective The aim of this study was to compare the diagnostic performance of clinical
vaginal examination with that of transvaginal sonography (TVS) in the presurgical
diagnosis of deep infiltrating endometriosis. Methods One-hundred and fifty-five women
with symptoms suggestive of endometriosis were included. One-hundred and twenty-nine
patients met the inclusion criteria and were prospectively and independently assessed
by vaginal examination and TVS prior to a diagnostic laparoscopy and, where appropriate,
radical resection and histological confirmation of endometriosis was performed. Sensitivity,
specificity, positive predictive values (PPV), negative predictive values (NPV) and
positive and negative likelihood ratios (LR+ and LR-) were calculated for each test
method. Results In total, 83 (64%) women had histological confirmation of endometriosis,
52 (40%) of whom had deep infiltrating endometriosis. The prevalence of endometriosis
on the uterosacral ligaments, pouch of Douglas, vagina, bladder, rectovaginal space
and rectosigmoid was 23.3%, 16.3%, 8.5%, 3.1%, 6.9% and 24%. PPV, NPV, LR+ and LR-
for vaginal examination were 92%, 87%, 41.56 and 0.60 for ovarian endometriosis; 43%,
84%, 2.48 and 0.63 for uterosacral ligament disease; 64%, 95%, 9.14 and 0.26 for involvement
of the pouch of Douglas; 80%, 97%, 42.91 and 0.28 for vaginal endometriosis; 78%,
98%, 46.67 and 0.23 for endometriosis of the rectovaginal space; 100%, 98%, 75.60
and 0.75 for bladder involvement; 86%, 84%, 18.97 and 0.63 for rectosigmoidal endometriosis.
Values for TVS were similar with regard to vaginal and rectovaginal space endometriosis,
but were clearly superior to vaginal examination in cases of ovarian (87%, 99%, 24.56
and 0.04), uterosacral ligament (91%, 90%, 31.35 and 0.37) and rectosigmoidal (97%,
97%, 88.51 and 0.1) endometriosis. Conclusions TVS is a more useful test than is vaginal
examination in detecting endometriosis in the ovaries and rectosigmoid. Copyright
(C) 2011 ISUOG. Published by John Wiley & Sons, Ltd.
