Abstract
Introduction: This study has been proposed to evaluate the feasibility of trans-vaginal and trans-abdominal ultrasound in screening of endometriosis.
 Methods: This was a retrospective observational study in which women with clinical symptoms, features and family history of endometriosis were included. Women with diagnosed endometriosis on treatment, with chocolate cystor adenomyosis were excluded. The ultrasound features in patients with suspected endometriosis were correlated with the laparoscopy findings and a new scoring system has been introduced to facilitate the management of the disease. Results: 2080 patients were examined clinically either by per-vaginal or by per-rectal examination (in adolescents, unmarried patients) and the findings were noted and ultrasound was performed. 489 of these women had undergone laparoscopy. Combined clinical score of 1-3 is associated with USG score 1. The visualisation shows that combined clinical score of 7-9 is associated with laparoscopy score 4 and combined clinical score of 1-3 is associated with laparoscopy score 2.Combined clinical score 10-12 is highly differentiated statistically. Conclusion: Clinical symptoms, signs along with USG findings have been seen to be quite helpful to screen endometriotic cases and thereby they should be followed up closely to detect its presence. In extremely doubtful cases laparoscopy should be performed for detection of the foresaid disease. It is very important to note that the clinical score and USG score corresponds to a large extent to laparoscopy score as mentioned in the results.
 Keywords: endometriosis, trans-vaginal, trans-abdominal, ultrasonography, clinical, score, laparoscopy
 List of abbreviations
 USG – Ultrasonography
 MRI –Magnetic Resonance Imaging
 POD- Pouch of Douglas
 VAS- Visual Analogue Scale
 TVS- Trans-vaginal ultrasonography
 TRUS- Trans-rectal ultrasonography
 USL- utero-sacral ligament
Highlights
This study has been proposed to evaluate the feasibility of trans-vaginal and trans-abdominal ultrasonography (USG) in screening of endometriosis
The bar graph (Figure 1) of combined clinical score clustered by laparoscopy score shows that maximum patients with laparoscopy score of 2 in combined clinical score of 1-3
The bar graph (Figure 2) of USG score clustered by laparoscopy score shows that maximum patients with laparoscopy score of 2 in USG score of 1 and 2
Summary
This was a retrospective observational study in which women with clinical symptoms, features and family history of endometriosis were included. About 11856 new patients had visited our clinic from January 2014- December 2018 out of which, 3556 (around 30%) patients had come up with complaints of pain during menstruation, chronic pelvic pain, irregular menstrual cycles or history of early menarche – all being symptoms suggestive of endometriosis. All these patients were examined clinically and subjected to ultrasonography (by abdominal or vaginal route) (USG). The study has been undertaken to find out if correlation of clinical symptoms and USG finding scan be used as a screening tool to detect early endometriosis (stage I and II) in these young women. Few of them had undergone laparoscopy as investigation for infertility and the findings were corroborated (Table 2)
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