Abstract
ABSTRACT
Background
Endometriosis is a chronic, inflammatory condition associated with pelvic pain, subfertility, and reduced quality of life. Advances in enhanced transvaginal ultrasound (eTVUS), including systematic compartment‐based scanning protocols and improved operator training, have increased diagnostic accuracy, particularly for deep endometriosis.
Aims
To evaluate and critically reflect on the diagnostic performance of eTVUS during its implementation prior to the adoption of standardised scanning protocols. Using the #ENZIAN classification system, the diagnostic performance of eTVUS was assessed by comparing ultrasound findings with laparoscopic visualisation as the reference standard.
Methods
A retrospective observational study of patients with suspected endometriosis who underwent preoperative eTVUS and subsequent laparoscopy between January 2015 and January 2024 at a single tertiary hospital. Ultrasound and surgical findings were mapped to #ENZIAN compartments and grades. Agreement and diagnostic metrics were calculated using laparoscopy as the reference standard.
Results
Among 221 patients with paired ultrasound and laparoscopy, adnexal endometriomas were detected with a sensitivity of 81.4% and specificity of 84.1%. Tubo‐ovarian complex disease demonstrated a sensitivity of 72.9% and specificity of 68.8%. Sensitivity for deep endometriosis was lower, with specificity for detection depending on anatomical location varying from 83%–95%. Bladder involvement had a PPV of 83.3% and NPV of 94.8%; ureteric disease had a PPV of 0% and NPV of ~100%. Peritoneal disease was rarely identified.
Conclusion
eTVUS demonstrated high diagnostic accuracy for ovarian endometriomas, moderate performance for bowel involvement, and low sensitivity for peritoneal disease.