The use of ultrasound‐based ‘soft markers’ for the prediction of pelvic pathology in women with chronic pelvic pain—can we reduce the need for laparoscopy?

Abstract

Objective To assess the accuracy of new transvaginal ultrasoundscan-based markers and to compare them to conventional ultrasound methods used in the detection of common pelvic pathology in women with chronic pelvic pain (CPP).Design A prospective observational study. Setting Teaching hospital.Population A total of 120 consecutive women with CPP undergoing transvaginal ultrasonography before either diagnostic or operative laparoscopy.Methods Anatomical abnormalities, e.g. endometrioma or hydrosalpinx (hard markers), were documented. The woman was then assessed for the presence or absence of 'soft markers' (reduced ovarian mobility and site-specific pelvic tenderness).Main outcome measure Presence or absence of pelvic pathology noted during laparoscopy.Results Seventy women had pelvic pathology, of whom 51 had endometriosis alone, 7 both endometriosis and pelvic adhesions, 6 pelvic adhesions, 1 hydrosalpinx with endometriosis and 5 hydrosalpinx and pelvic adhesions. The likelihood ratio for the hard markers was infinity (specificity was 100%), for the soft makers 1.9 (95% CI 1.2-3.1) and for a 'normal' ultrasound 0.18 (0.09-0.34). The pre-test probability of pelvic disease in our population of women with CPP was 58%, and this probability of disease was raised to 100% with the presence of hard markers and to 73% with the presence of soft markers. The pre-test probability of 58% fell to 20% when ultrasound finding was found to be normal. ConclusionThis new approach improves the detection and exclusion of significant pathology in women with CPP and may lead to a reduction in the number of unnecessary laparoscopies carried out on women with CPP.

The ‘sliding sign’ in conjunction with sonovaginography: is this the optimal approach for the diagnosis of Pouch of Douglas obliteration and posterior compartment deep infiltrating endometriosis?

“…Studies have described the sonologic features characteristic of endometriotic nodules as regular/irregular hypoechogenic nodular or cystic structures affecting the urinary bladder, vaginal wall, recto‐sigmoid, utero‐sacral ligament and rectovaginal septum 16 24 , 25 These lesions generate site specific tenderness on probe palpation 18 , 19 , 26 and could result in uterine malposition with tethering of the uterus to surrounding pelvic structures 11 20 Indeed, uterine position has been described as a predictor of posterior compartment DIE.…”

Chronic Pelvic Pain in Adolescents Transvaginal ultrasound Versus Laparoscopy, A Prospective Cross Sectional Observational Study

“…This difference was due to the higher prevalence of sexually transmitted diseases in such community when compared to our community 13 .…”

“…The overall incidence of PID as a cause of pelvic pain (4%) was much lower than Okaro et al, (2006) who found PID in (20%) of cases. This difference was due to the higher prevalence of sexually transmitted diseases in such community when compared to our community 13 .…”

Imaging in gynecology

“…Imaging methods to diagnose adenomyosis have been described above (Table 5). Okaro et al [156] invented the ultrasound term 'soft marker' to indicate pelvic pathology in women with chronic pelvic pain, the 'soft markers' being presence of immobile ovaries and/or site specific tenderness and/or loculated pelvic fluid at transvaginal ultrasound examination. They found these soft markers to indicate significant pelvic pathology with a positive likelihood ratio of 1.9 and a negative likelihood ratio of 0.2.…”