Abstract
Objective
Evaluate whether symptoms and/or transvaginal ultrasound (TVS) ‘soft markers’ (ovarian
immobility and/or site-specific tenderness (SST)) are associated with endometriosis
type/location.
Study design
Multicenter prospective observational study (January 2009 to February 2013) in tertiary
centers for women with chronic pelvic pain who underwent detailed history, specialized
TVS, and laparoscopy. Chart findings were collated into a study database. Outcome
measures included correlation between symptoms, ovarian immobility or SST on TVS and
endometriosis type and/or location. The performance of ovarian immobility to predict
ipsilateral SE was evaluated in terms of accuracy, sensitivity, specificity, positive
predictive value (PPV) and negative predictive value (NPV).
Results
A total of 189 participants were included. Ovarian immobility on TVS was significantly
associated with: ipsilateral pelvic pain, uterosacral ligament (USL) and pelvic sidewall
superficial endometriosis (SE), endometrioma, posterior compartment deep endometriosis
(DE), pouch of Douglas (POD) obliteration, and need for bowel surgery (all p < 0.05). For women with isolated SE (i.e.no endometrioma, DE, or POD obliteration),
left ovarian immobility was significantly associated with left USL SE (p = 0.01) and left adnexal SST corresponded to left pelvic sidewall SE (p = 0.03). The accuracy, sensitivity, specificity, PPV and NPV for ovarian immobility
at TVS and the presence of ipsilateral pelvic sidewall SE for the left ovary was:
71%, 16%, 87%, 27% and 78%, respectively; and for the right ovary was: 82%, 7.0%,
94%, 14% and 87%, respectively.
Conclusion
Ovarian immobility on TVS was significantly associated with ipsilateral pelvic pain,
USL/pelvic sidewall SE, endometrioma, posterior compartment DE, and POD obliteration.
The diagnostic accuracy of ovarian immobility for disease location in women with isolated
SE showed a high specificity and NPV, but poor sensitivity and PPV, suggesting that
ipsilateral pelvic sidewall SE is less likely to be present in women with a mobile
ovary (in the absence of endometrioma or DE). Larger studies are required to further
evaluate the usefulness of soft markers for the localization of isolated SE.
Keywords
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Article info
Publication history
Published online: January 22, 2019
Accepted:
January 14,
2019
Received in revised form:
January 12,
2019
Received:
September 26,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
