Journal Article

Diagnostic value of transvaginal ‘tenderness-guided’ ultrasonography for the prediction of location of deep endometriosis

Stefano Guerriero, Silvia Ajossa, Marta Gerada, Bruna Virgilio, Stefano Angioni and Gian Benedetto Melis

in Human Reproduction

Published on behalf of European Society of Human Reproduction and Embryology

Volume 23, issue 11, pages 2452-2457
Published in print November 2008 | ISSN: 0268-1161
Published online July 2008 | e-ISSN: 1460-2350 | DOI:
Diagnostic value of transvaginal ‘tenderness-guided’ ultrasonography for the prediction of location of deep endometriosis

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The aim was to evaluate the diagnostic accuracy of transvaginal tenderness-guided ultrasonography in the identification of location of deep endometriosis.


Consecutive women scheduled for surgery in our Department for clinically suspected endometriosis were included in this prospective study. All women underwent modified transvaginal ultrasonography using a stand-off in the week before surgery, which also evaluated the painful sites evocated by a gentle pressure of the probe. Five locations of deep endometriosis were considered: vaginal walls, rectovaginal septum, rectosigmoid involvement, uterosacral ligaments and anterior compartment (anterior pouch and/or bladder). Sensitivity, specificity and likelihood ratios (LR+/−) were calculated with 95% confidence intervals (CIs).


We included 88 women; surgery associated with histopathological evaluation revealed deep endometriosis in different pelvic locations in 72 patients. With respect to the vaginal walls, transvaginal ultrasonography had a sensitivity of 91% (95% CI, 79–97%), specificity of 89% (95% CI, 81–93%), an LR+ of 8.2 and an LR− of 0.09. For endometriosis of rectovaginal septum, transvaginal ultrasonography had a sensitivity of 74% (95% CI, 64–80%), specificity of 88% (95% CI, 4–8%), an LR+ of 6.2 and an LR− of 0.3. For other locations, the sensitivity was lower (ranging from 67% to 33%) with a comparable specificity.


This technique shows a high specificity and sensitivity in the detection of vaginal and rectovaginal endometriosis. Good specificity associated with a lower sensitivity was obtained in the diagnosis of deep endometriosis of uterosacral ligaments, rectosigmoid involvement or anterior deep endometriosis.

Keywords: transvaginal ultrasonography; deep endometriosis; sensitivity; specificity

Journal Article.  3284 words.  Illustrated.

Subjects: Reproductive Medicine

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