To evaluate the diagnostic accuracy of transvaginal ultrasound in predicting a laparoscopic surgically assigned revised American Society of Reproductive Medicine (ASRM) endometriosis stage.
Multicenter retrospective diagnostic accuracy study.
Patients attended one of two academic gynecologic ultrasound units and underwent laparoscopy by one of six surgeons in metropolitan Sydney, Australia between 2016 and 2018.
Two hundred and four patients with suspected endometriosis.
Ultrasound followed by laparoscopy MEASUREMENTS AND MAIN RESULTS: Surgical cases were identified. The preoperative ultrasound report and surgical operative notes were each used to retrospectively assign an ASRM score and stage. The breakdown of surgical findings is as follows: ASRM 0 (i.e. no endometriosis), 24/204 (11.8%); ASRM 1, 110/204 (53.9%); ASRM 2, 22/204 (10.8%); ASRM 3, 16/204 (7.8%); ASRM 4, 32/204 (15.7%). The overall accuracy of ultrasound to predict the surgical ASRM stage is as follows: ASRM 1, 53.4%; ASRM 2, 93.8%; ASRM 3, 89.7%; ASRM 4, 93.1%; grouped ASRM 0/1/2, 94.6%; ASRM 3/4 of 94.6%. Ultrasound has better test performance in higher disease stages. When the ASRM stages are dichotomized, ultrasound has sensitivity and specificity for ASRM 0/1/2 of 94.9% and 93.8% and ASRM 3/4 of 93.8% and 94.9%.
Ultrasound has high accuracy in predicting mild, moderate, and severe ASRM stage of endometriosis and can accurately differentiate between stages when ASRM stages are dichotomized (nil/minimal/mild versus moderate/severe). This can have major positive implications on patient triaging to centers of excellence in minimally-invasive gynecology for advanced-stage endometriosis.

Copyright © 2020. Published by Elsevier Inc.