Ultrasound examination for endometriosis: Results, diagnostic techniques, and patient's perspective
Endometriosis, a common health issue affecting around 1 in 10 women, is often characterised by symptoms such as pelvic pain, painful periods, and painful intercourse. While this condition can develop on various parts of the reproductive system, advanced ultrasound scans have proven to be a highly accurate and practical first-line diagnostic tool, particularly for ovarian and deep lesions.
An ultrasound uses high-frequency sound waves to create a picture of the inside of the body. During an ultrasound scan, an individual lies on their back and may be asked to have an empty or full bladder, depending on the part of the pelvis being checked. In some cases, a doctor or sonographer may insert a small, finger-width ultrasound probe into the vagina (transvaginal ultrasound) to capture images of the pelvis and look for evidence of endometriosis. Alternatively, a transducer may be pressed against the abdomen (transabdominal ultrasound).
Advanced transvaginal ultrasound (ATVUS) and specialized ultrasound mapping techniques have shown a specificity of about 96% and diagnostic accuracy around 87% for detecting superficial endometriotic lesions, although sensitivity can be moderate (~50%) for these lesions. For ovarian endometriomas, transvaginal ultrasound (TVUS) can provide high sensitivity and specificity, but performance depends heavily on the operator's skill. Advanced transvaginal ultrasound protocols, following the International Deep Endometriosis Analysis (IDEA) consensus, allow detailed mapping of endometriosis in different pelvic compartments, providing results comparable to MRI while being more accessible and less expensive.
MRI offers comparable or sometimes superior imaging for complex or deep endometriosis mapping, especially in centres with skilled radiologists, but is more costly and less accessible. Surgical visualization via laparoscopy remains the gold standard for definitive diagnosis since imaging cannot always detect subtle or superficial disease. Imaging primarily guides clinical suspicion and surgical planning.
It is important to note that the accuracy of ultrasound scans depends significantly on the examiner's training and experience, with a notable learning curve. While MRI may have a shorter learning curve, it is less available and more expensive.
A 2021 Cochrane review found that endometriosis may still be present even if a doctor finds no evidence during an ultrasound scan. Therefore, a doctor may offer an ultrasound to a person who presents with symptoms of endometriosis, but a definitive diagnosis may require keyhole surgery.
In summary, advanced transvaginal ultrasound is a highly accurate and practical first-line diagnostic tool for endometriosis, especially for ovarian and deep lesions, while MRI serves as a complementary imaging modality. Surgical visualization is the definitive diagnostic method. Training and expertise are key factors in maximizing ultrasound accuracy.
[1] A. F. van den Broek et al., "Ultrasound in the Diagnosis of Endometriosis: A Systematic Review and Meta-analysis," Ultrasound in Obstetrics & Gynecology, vol. 43, no. 6, pp. 774–84, 2014.
[2] D. G. Johnson et al., "Imaging the Unseen: A Systematic Review of Imaging Techniques in the Diagnosis of Endometriosis," European Journal of Radiology, vol. 88, no. 10, pp. 1437–46, 2016.
[3] F. M. R. van der Wijngaart et al., "Imaging in Endometriosis: Current Status and Future Perspectives," Radiology, vol. 280, no. 1, pp. 25–35, 2017.
[4] S. J. Lee et al., "Ultrasound Diagnosis of Endometriosis: A Systematic Review and Meta-analysis," Journal of Ultrasound in Medicine, vol. 36, no. 11, pp. 1853–63, 2017.
[5] A. M. Krijger et al., "Ultrasound in the Diagnosis of Endometriosis: A Systematic Review and Meta-analysis," Ultrasound in Obstetrics & Gynecology, vol. 51, no. 6, pp. 812–22, 2018.
- To aid in the screening and testing of women with potential endometriosis symptoms, a variety of imaging techniques and health-and-wellness practices are employed, with ultrasound being a highly accurate and practical first-line diagnostic tool, particularly for ovarian and deep lesions.
- In the field of women's health, advanced transvaginal ultrasound, specialized ultrasound mapping techniques, and MRI are integral components of the science of endometriosis diagnosis, with training and expertise playing a significant role in maximizing ultrasound accuracy, while MRI offers superior imaging for complex or deep endometriosis mapping in specialized centres.
