Preoperative Triple Pelvic Examination and Transvaginal Sonography: Diagnostic Predictive Value for Posterior Pelvic Deep Endometriosis.

In 30 seconds

This prospective randomized controlled clinical study assessed whether triple pelvic examination, alone or combined with transvaginal sonography (TVS), predicts posterior pelvic deep endometriosis in 85 patients undergoing endometriosis surgery. Preoperative Enzian scores were compared with intraoperative scores. Clinical examination was more sensitive than TVS for uterosacral ligament (USL) lesions, whereas TVS was better for lesions in the pouch of Douglas. Combining the assessments improved sensitivity and accuracy, particularly for USL involvement: TVS sensitivity was 68.18% when sonographers received examination findings beforehand, compared with 38.10% for TVS performed independently (p = .023).

Key findings

• Triple pelvic examination had higher sensitivity than TVS for USL lesions in both groups (p = .002 and p = .049).
• TVS was superior to triple pelvic examination for detecting pouch-of-Douglas deep endometriosis (p = .001 and p = .049).
• For USL lesions, TVS sensitivity was 68.18% with prior examination findings versus 38.10% with TVS alone (p = .023).
• Combining examination and TVS improved sensitivity and accuracy for deep pelvic lesions, particularly USL involvement.

Why it matters

Posterior pelvic deep endometriosis can involve sites that are assessed differently by clinical examination and imaging. These findings suggest that the methods may provide complementary preoperative information, with examination findings potentially improving sonographic detection of USL disease. More accurate preoperative mapping may help characterize disease before surgery, although the study does not establish effects on surgical or patient outcomes.

What to keep in mind

The study included 85 patients at a single hospital; the abstract reports diagnostic performance but not effects on surgical or patient outcomes.