Transvaginal Three-dimensional Ultrasonography Combined with Serum CA 125 Level for the Diagnosis of Pelvic Adhesions before Laparoscopic Surgery

Abstract

Study Objective To investigate the role of transvaginal three-dimensional ultrasonography combined with serum CA 125 level in diagnosing pelvic adhesions before scheduled laparoscopic surgery. Design Prospective study (Canadian Task Force classification II-1). Setting Tertiary care academic hospital. Patients Fifty-nine women with an adnexal mass diagnosed by two-dimensional transvaginal ultrasonography. Intervention Preoperative transvaginal three-dimensional ultrasonography and serum CA 125 level, followed by laparoscopy or laparotomy. Measurements and Main Results Pelvic adhesions were correctly identified by transvaginal three-dimensional ultrasonography in 26 of 32 women in whom the lesions were confirmed at laparoscopy or laparotomy. Mean serum CA 125 level in women with adhesions was 70 ± 73.7 U/ml, which was significantly higher than that in women without adhesions (24 ± 16.16 U/ml, p = 0.004). The sensitivity of combined transvaginal three-dimensional ultrasonography and serum CA 125 level was 90%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 89%. The two methods showed strong agreement with surgical results (κ = 0.889). Eight scheduled laparoscopies (13.6%) were converted to laparotomy due to severe adhesions. One patient (1.7%) experienced colon injury during laparoscopic adhesiolysis. Conclusion Transvaginal three-dimensional ultrasonography combined with serum CA 125 level is sensitive in detecting pelvic adhesions before laparoscopic surgery. Patients with suspected severe pelvic adhesions should have preoperative bowel preparation to reduce the risk of intraoperative injury.