A new consensus statement from the Society of Radiologists in Ultrasound (SRU) has been released with the goal of enhancing the evaluation of endometriosis. This condition is common and often goes undiagnosed, causing patients to suffer from pain, infertility, financial losses, and strained relationships. The consensus offers recommendations for improving the diagnosis of deep endometriosis by using additional techniques and imaging alongside routine pelvic ultrasounds. The expert consensus statement is published in the journal Radiology.Endometriosis is a common condition that is often diagnosed late, causing patients to suffer from pain, infertility, financial loss, and strained relationships. The consensus recommends enhancing routine pelvic ultrasounds with additional techniques and imaging to better detect deep endometriosis. Endometriosis, which involves the growth of tissue similar to the uterine lining outside the uterus, is a prevalent and potentially disabling condition. It is estimated to affect 10% of women of reproductive age and is present in 21% of women who undergo hysterectomy for chronic pelvic pain. In the United States, there is an overwhelmingly high number of cases.Ten years is the average time it takes for a diagnosis of endometriosis to be made after symptoms first appear. Endometriosis is linked to infertility and subfertility, with 20-50% of affected patients experiencing these conditions. The most severe form of endometriosis is deep endometriosis, which extends beneath the peritoneal surface. Ultrasound is typically the first imaging method used for chronic pelvic pain and infertility, both common symptoms of endometriosis. However, only a few centers in the U.S. use ultrasound to screen for deep endometriosis due to limitations in scan protocols and lack of awareness.Detection of deep endometriosis using pelvic ultrasounds can be challenging at times. To address this issue, the Society of Radiologists in Ultrasound (SRU) brought together a team of experts from various disciplines to develop recommendations aimed at enhancing the screening process for endometriosis. The primary goal of the consensus panel is to propose methods that can improve the diagnostic sensitivity of endometriosis on pelvic ultrasound. This includes increasing awareness, refining interpretation, incorporating simple yet effective techniques for deep endometriosis, and enhancing protocols for patient triage. Scott W. Young, M.D., a diagnostic radiology consultant, is the first author of the statement.Ultrasound, at the Mayo Clinic in Phoenix, Arizona.
A group of specialists with expertise in imaging and treating endometriosis, such as radiologists, sonographers, gynecologists, reproductive endocrinologists, and minimally invasive gynecologic surgeons, formed the panel. They used a combination of a thorough review of the literature and a modified Delphi technique to reach an agreement.
<p”The statement outlines the specific population that should undergo screening, explains ways to enhance pelvic ultrasound, sets criteria for identifying endometriosis through ultrasound, establishes a system for grading and reporting observations. Dr. Young explained that additional imaging and patient management are important for improving the detection of endometriosis. The panel recommends specific techniques, such as transvaginal ultrasound and the uterine sliding sign maneuver, to help with this. Dr. Young also noted that these techniques can be done quickly, in less than five minutes, and may help reduce the time it takes to diagnose endometriosis in at-risk patients. The panel also suggests that deep endometriosis should be carefully assessed during the exam, and the results should be reviewed directly and indirectly.The report is divided into four categories: Incomplete (APU-0), Normal (APU-1), Equivocal (APU-2), and Positive (APU-3), each with their respective management recommendations.
Dr. Young explained that the consensus on routine pelvic ultrasound for endometriosis is aimed at improving the detection of deep endometriosis, even during the initial ultrasound, with minimal additional time required for imaging and no special patient preparation. By focusing the imaging on anatomical regions where deep endometriosis is common, detection can be enhanced and diagnostic delay can be reduced.
It is important to note that these guidelines are intended for symptomatic patients at typical risk for endometriosis. Patients rnrnPatients who have had laparoscopy for endometriosis or have strong clinical indications are at a high risk and may benefit from advanced endometriosis imaging, especially if they are likely to undergo surgery or need monitoring for infertility and medical treatment.
The authors suggest that validation studies are needed to confirm the accuracy of augmented pelvic ultrasound in widespread clinical use.
