Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign

Authors

  • S. Reid,

    Corresponding author
    • Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Penrith, NSW, Australia
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  • C. Lu,

    1. Department of Computer Sciences, University of Wales, Aberystwyth, UK
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  • I. Casikar,

    1. Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Penrith, NSW, Australia
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  • G. Reid,

    1. St Luke's Hospital, Potts Point, NSW, Australia
    2. St George Private Hospital, Kogarah, NSW, Australia
    3. Prince of Wales Private Hospital, Randwick, NSW, Australia
    4. Liverpool Public Hospital, Liverpool, NSW, Australia
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  • J. Abbott,

    1. Prince of Wales Private Hospital, Randwick, NSW, Australia
    2. University of New South Wales, Randwick, NSW, Australia
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  • G. Cario,

    1. St George Private Hospital, Kogarah, NSW, Australia
    2. Hurstville Private Hospital, Hurstville, NSW, Australia
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  • D. Chou,

    1. St George Private Hospital, Kogarah, NSW, Australia
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  • D. Kowalski,

    1. Prince of Wales Private Hospital, Randwick, NSW, Australia
    2. Royal Prince Alfred Hospital, Department of Obstetrics and Gynaecology, University of Sydney, Camperdown, NSW, Australia
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  • M. Cooper,

    1. Royal Prince Alfred Hospital, Department of Obstetrics and Gynaecology, University of Sydney, Camperdown, NSW, Australia
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  • G. Condous

    1. Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Penrith, NSW, Australia
    2. Omni Gynaecological Care Centre for Women's Ultrasound and Early Pregnancy, St Leonards, NSW, Australia
    3. Norwest Private Hospital, Bella Vista, NSW, Australia
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Correspondence to: Dr S. Reid, Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Penrith, NSW, Australia (e-mail: sereid@gmail.com)

ABSTRACT

Objective

To evaluate preoperative real-time dynamic transvaginal sonography (TVS) in the prediction of pouch of Douglas (POD) obliteration in women undergoing laparoscopy for suspected endometriosis.

METHODS

This was a multicenter prospective observational study undertaken from January 2009 to November 2011. All women with symptoms suggestive of endometriosis who were scheduled for laparoscopy underwent detailed preoperative TVS, in particular to ascertain whether the POD was obliterated. POD obliteration was assessed using a real-time TVS technique called the ‘sliding sign’. Preoperative TVS sliding sign findings were then compared to gold standard laparoscopic POD findings.

Results

One hundred consecutive women with preoperative TVS and laparoscopic outcomes were included in the final analysis. Mean age was 32.8 years and mean age at diagnosis of endometriosis was 27.4 years. At laparoscopy, 84/100 (84%) were found to have some form of endometriosis (73% peritoneal endometriosis, 35% ovarian endometrioma(s), 33% deep infiltrating endometriosis). At laparoscopy, 30/100 (30%) had an obliterated POD and 19/30 (63.3%) of these women also had evidence of bowel endometriosis. The sonographic sliding sign technique had an accuracy of 93.0%, sensitivity of 83.3%, specificity of 97.1%, positive predictive value of 92.6%, negative predictive value of 93.2%, positive likelihood ratio of 29.2 and negative likelihood ratio of 0.17 in the prediction of POD obliteration (P = 1.8E−16).

Conclusions

Preoperative real-time dynamic TVS evaluation using the sliding sign seems to establish with a high degree of certainty whether the POD is obliterated. Given the increased risk of deep infiltrating endometriosis in women with POD obliteration, the TVS sliding sign technique may also be useful in the identification of women who may be at a higher risk for bowel endometriosis. Copyright © 2012 ISUOG. Published by John Wiley & Sons Ltd.

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