Diagnostic Accuracy Of Transvaginal Ultrasonography For Diagnosis Of Ovarian Endometriosis Taking Laproscopy As Gold Standard

  • Asma Maqsood Senior Registrar Pakistan Kidney and Liver Institute and Research Center
  • Sehrish Rubab Senior Registrar Mayo Hospital Lahore
  • Abeer Yasin Senior Registrar Lahore General Hospital
  • Muhammad Salman Rafique Consultant Radiologist Pakistan Kidney and Liver Institute and Research Center
  • Sana Kundi Consultant Radiologist Pakistan Kidney and Liver Institute and Research Center
  • Kayenat Khan Pakistan Kidney and Liver Institute and Research Center
Keywords: Transvaginal Ultrasonography (TVS), Laparoscopy, Ovarian Endometriosis, diagnostic accuracy



Endometriosis is a common gynecological condition in the reproductive age, defined as the presence of endometrial-like tissue outside the uterus, which impairs quality of life. The clinical features are highly variable with surgery as the only method to make a definitive diagnosis. Noninvasive diagnostic testing, such as transvaginal ultrasonography (TVS), is usually performed because of its availability, high diffusion, relatively low cost, patient acceptability, and particularly because it is the most accurate diagnostic modality for endometriosis. The goal of this study was to assess the diagnostic accuracy of TVS in the diagnosis of ovarian endometriosis by taking laparoscopic findings as the gold standard.

 Patients and Method

It was a cross sectional study conducted in Radiology Department of Sir Ganga Ram Hospital, Lahore from 11-06-2017 to 11-12-2018. 125 females fulfilling inclusion criteria were referred to Radiology Department from Gynaecology OPD and were enrolled in the study after taking informed consent. Demographic data and the duration of symptoms were recorded and the patients were undergone TVS scan using endovaginal probe having frequency 6 MHz by the researcher. Patients were labeled as positive or negative as per their findings. Then patients underwent laparoscopy by a single senior gynecologist. Reports were assessed and patients were confirmed as positive or negative for ovarian endometriosis. Data was analyzed by SPSS 20. A 2x2 contingency table was generated to calculate sensitivity, specificity, PPV, NPV and accuracy.


The mean age of the patients was illustrated to be37.4 ± 2.67 years of which the minimum age was 25 years and maximum of 37 years. Out of 125 women who underwent preoperative TVS the diagnosis of ovarian endometriosis was positive in 99 (79.2%) and observed negative in 26 (20.8%) on TVS. However; at laparoscopy 106 (84.8%) women had evidence of ovarian endometriosis and 19 (15.2%) were detected negative. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value TVS was established to be 91.2%, 91.5%, 89.5%, 98%, and 65.4%, respectively by taking laparoscopy as gold standard among patients presenting with the symptoms of pain, secondary dysmenorrhea or infertility


Our study results has shown that the TVS had better sensitivity and specificity in the diagnosis of endometriosis which is a cheap and accessible diagnostic tool and can be recommended in daily clinical practice.

Original Articles