TVUS soft markers in clinically significant superficial endometriosis: an ultrasonographic, clinical, and laparoscopic correlation

Abstract

Introduction: Ultrasonographic soft markers can be useful diagnostic findings in endometriosis. We evaluated women with superficial endometriosis with only soft markers on basal transvaginal ultrasound (TVUS) with bowel preparation and their relationship with chronic pelvic pain and laparoscopy findings. Materials and methods: This retrospective cohort study included patients with clinical suspicion of endometriosis. They had soft markers on basal TVUS with bowel preparation and underwent laparoscopy for the first time. Symptoms, such as dysmenorrhea, dyschezia, deep dyspareunia, and dysuria, were quantified with a visual analog scale. The ultrasonographic soft markers were ovarian tenderness, adhesions, obliteration of the cul-de-sac (CDS), and obliteration of the vesico-uterine pouch (VUP). Laparoscopic findings were adhesions and superficial endometriotic lesions. Results: A total of 25 women with superficial endometriosis with only soft markers on basal TVUS with bowel preparation and who underwent therapeutic laparoscopy were included. The mean age was 32.28 ± 5.67 years. The type and intensity (mean ± SD) of chronic pelvic pain were severe dysmenorrhea (7.60 ± 3.08), moderate dyspareunia (4.84 ± 3.51), and mild dyschezia and dysuria (3.44 ± 3.89 and 2.12 ± 2.92, respectively). All had at least one positive ultrasonographic soft marker. Most patients had moderate-to-severe dysmenorrhea and only soft markers on ultrasound examinations. Patients with superficial endometriotic lesions, regardless of size or extension, found at laparoscopy reported severe dysmenorrhea. Conclusion: TVUS soft markers were associated with clinically significant superficial endometriosis. TVUS soft markers are not usually reported during routine examination. They may improve the diagnostic yield of superficial endometriosis.