Diagnosis of pelvic adhesions in patients with endometrioma: the role of transvaginal ultrasonography

Objective To estimate the diagnostic value of transvaginal ultrasonography in the detection of pelvic adhesions in women suspected of having endometriomas at ultrasonography. Design Prospective observational study. Setting Academic Department of Obstetrics and Gynecology. Patient(s) One hundred thirteen women who underwent surgery for an endometrioma. Intervention(s) All patients underwent transvaginal ultrasonography before surgery, and at ultrasonography the presence of fixation of the ovary to the uterus was considered characteristic of the presence of pelvic adhesions. Main Outcome Measure(s) Sensitivity, specificity, and likelihood ratios were calculated with 95% confidence intervals (CIs). Result(s) The sensitivity and specificity of the fixation to the uterus of at least one ovary were respectively 89% (95% CI 84%–92%) and 90% (95% CI 76%–97%). The likelihood ratio for fixation of at least one ovary to the uterus was 8.92 (95% CI 3.04–26) and for a “normal” ultrasound examination 0.12 (95% CI 0.06–0.23). The pretest probability of pelvic adhesions was 74%, and this probability increased to 96% when fixation of at least one ovary to the uterus was present and fell to 27% when this ultrasonographic finding was absent. Conclusion(s) Transvaginal ultrasonography seems to be able to detect or exclude the presence of adhesions in women with ultrasonographic suspicion of endometrioma.