Transvaginal Ultrasound in the Diagnosis and Assessment of Endometriosis—An Overview: How, Why, and When

Abstract

Endometriosis is a common gynaecological disease, causing symptoms such as pelvic pain and infertility. Accurate diagnosis and assessment are often challenging. Transvaginal ultrasound (TVS), along with magnetic resonance imaging (MRI), are the most common imaging modalities. In this narrative review, we present the evidence behind the role of TVS in the diagnosis and assessment of endometriosis. We recognize three forms of endometriosis: Ovarian endometriomas (OMAs) can be adequately assessed by transvaginal ultrasound. Superficial peritoneal endometriosis (SUP) is challenging to diagnose by either imaging modality. TVS, in the hands of appropriately trained clinicians, appears to be non-inferior to MRI in the diagnosis and assessment of deep infiltrating endometriosis (DIE). The IDEA consensus standardized the terminology and offered a structured approach in the assessment of endometriosis by ultrasound. TVS can be used in the non-invasive staging of endometriosis using the available classification systems (rASRM, #ENZIAN). Given its satisfactory overall diagnostic accuracy, wide availability, and low cost, it should be considered as the first-line imaging modality in the diagnosis and assessment of endometriosis. Modifications to the original ultrasound technique can be employed on a case-by-case basis. Improved training and future advances in ultrasound technology are likely to further increase its diagnostic performance.

Diagnosis of Endometriosis by Transvaginal Ultrasound: An Online Survey of Gynecologists Practising in Greece

“…We identify a strong statistically significant correlation between the clinicians' belief of TVS's ability and their own clinical practice, both for endometrioma as well as all DE locations. We feel that this is a reflection of the clinicians' general skepticism over the true role and value of TVS in the diagnosis and assessment of DE in general, in spite of the existing literature [ 4 - 9 ]. Other than an association between the number of TVS per year and diagnosis of bowel DE in clinical practice, we did not identify a significant association between the participants' professional role, years of experience, or number of TVSs per year and answers to all other questions.…”

“…There is a growing body of evidence suggesting that TVS should be a first-line tool in the investigation of women with endometriosis [ 5 , 9 ]. This was also reflected in our survey, as 63 out of 64 gynecologists (98.44%) that took part in our survey expressed the same opinion.…”

“…Endometriosis is a heterogeneous disease, and three phenotypes are commonly recognized: superficial peritoneal lesions (SUP), ovarian endometriomas (OMA), and deep endometriosis (DE) [3]. Although diagnostic laparoscopy may still be considered the gold standard in the diagnosis of endometriosis by many, as it allows direct visualization of the lesions, numerous studies have demonstrated the importance of transvaginal ultrasound scan (TVS) as a first-line imaging tool in the accurate diagnosis and pre-operative staging of endometriosis [4][5][6][7][8][9]. Despite this, gynecologists still appear to have poor awareness of TVS's role in the assessment of women with known or suspected endometriosis [10].…”

Feasibility of Predicting Surgical Duration in Endometriosis Using Numerical Multi-Scoring System of Endometriosis (NMS-E)

“…Despite its convenience and the availability of a supportive app, this method still faces technical difficulties in assessing peritoneal, tubal, and ureteral lesions via ultrasonography [ 11 ]. It may not clarify the relationship between lesions and pain either [ 13 , 16 ].…”