Diagnosis of endometriosis of the rectovaginal septum using introital three-dimensional ultrasonography

Objective: To evaluate the diagnostic accuracy of introital three-dimensional (3D) transvaginal sonography for preoperative detection of rectovaginal septal endometriosis. Design: Ultrasonographic results were compared with surgical and histologic findings. Setting: University Department of Obstetrics and Gynecology. Patient(s): This prospective study included 39 women with suspected rectovaginal endometriosis. Intervention(s): All patients underwent 3D transvaginal sonography for the evaluation of the rectovaginal septum, before undergoing laparoscopic radical resection of endometriosis. Rectovaginal endometriosis was defined as hypoechoic areas, nodules, or anatomic distortion of this specific location. Main Outcome Measure(s): Sensitivity, specificity, and likelihood ratios (positive or negative) were calculated with 95% confidence intervals (CIs). Result(s): Surgery associated with histopathologic evaluation revealed deep endometriosis in the rectovaginal septum in 19 patients. The specificity, sensitivity, positive likelihood ratio, and negative likelihood ratio were 94.7% (95% CI, 78.6%-99.7%), 89.5% (95% CI, 73.3%-94.5%), 17.2 (95% CI, 2.51-115), and 0.11 (95% CI, 0.03-0.41), respectively. Conclusion(s): Introital 3D ultrasonography seems to be an effective method for the diagnosis of endometriosis of the rectovaginal septum and should be included in the preoperative evaluation of patients with clinical suspicion of deep endometriosis. (Fertil Steril (R) 2010;94:2761-5. (C) 2010 by American Society for Reproductive Medicine.)