Anatomical Distribution of Deep Endometriosis on Transvaginal Ultrasound and Clinical Features: Implications on Non-Invasive Diagnosis

Abstract

<h3>Study Objective</h3> There is a significant evidence gap in correlating clinical features and symptoms of endometriosis to disease patterns, driving the initiative of using more detailed and standardised clinical data to guide research into possible clinical-anatomical associations. The study aims to determine the anatomic distribution of DE, provide an epidemiological overview based on advanced transvaginal ultrasound (aTVS), and describe the possible relationship with clinical features obtained with the World Endometriosis Foundation (WERF) Questionnaire. <h3>Design</h3> Retrospective cross-sectional study. <h3>Setting</h3> Analysis of ultrasound records and clinical questionnaire. <h3>Patients or Participants</h3> 316 <h3>Interventions</h3> N/A <h3>Measurements and Main Results</h3> Preliminary data showed that from 316 (n=316) aTVS scans, the most frequent DE lesions were found in at least one of these locations (at least one lesion, not excluding multiple nodules in the same patient): <b>uterosacral ligaments</b>, 20% (right n=59, 20% and left n=58 (19.7%); <b>bowel</b> 19% (predominantly upper rectum, n=36, 12.2%); and <b>ovaries</b> 13.6% (right n=40, 13.6% and left n=37, 12.6%). The most frequent dynamic abnormalities were found in the Pouch of Douglas (POD), with a <b>negative "sliding sign"</b>: n=85, 28.9% (complete obliteration n=45, 15.3%; and partial obliteration n=40, 13.6%). Also common, soft markers such as reduced ovarian mobility (of at least one of the ovaries): 20.7% (left ovary n=61, 20.7%; right ovary n=52, 17.7%). <h3>Conclusion</h3> The identification of pelvic abnormalities through aTVS inthis specific population is notably high. Previous knowledge of the typical anatomical distribution of DE has the potential to provide an orientation to guide a more targeted diagnosis, likely reducing the number of false negatives of diagnostic tests and increasing the chances of a more satisfactory outcome in surgical procedures. Furthermore, with the highly detailed WERF questionnaire associated with the thorough aTVS findings, we aim to provide evidence to fill a long-term knowledge gap between clinical features and symptoms to specific pelvic endometriosis distribution characteristics.