A new expert consensus statement from the Society of Radiologists in Ultrasound (SRU) was recently published in the journal Radiology, focusing on improving the evaluation of endometriosis. Endometriosis is a common condition that often leads to significant diagnostic delays, resulting in pain, infertility, lost wages, and disrupted relationships for patients. The consensus provides recommendations for enhancing routine pelvic ultrasounds through additional maneuvers and imaging to improve the diagnosis of deep endometriosis, a severe form of the condition.
Endometriosis is characterized by the presence of endometrium-like tissue outside the uterus and affects approximately 10% of women of reproductive age. It is estimated to occur in 21% of women undergoing hysterectomy for chronic pelvic pain. The United States currently faces a diagnostic delay of over seven years from the onset of symptoms to an endometriosis diagnosis, leading to significant health and quality of life issues for patients. Additionally, endometriosis is associated with infertility and subfertility, impacting 20-50% of patients with these conditions.
Ultrasound is typically the first-line imaging modality used when patients present with chronic pelvic pain or infertility issues, common symptoms of endometriosis. However, many centers in the U.S. do not utilize ultrasound for screening deep endometriosis due to existing scan protocol limitations and lack of awareness. As a result, the detection of deep endometriosis on pelvic ultrasounds is often suboptimal. In response, the SRU convened a panel of experts from various disciplines to develop recommendations aimed at improving the screening process for endometriosis.
The consensus panel’s recommendations include techniques such as transvaginal ultrasound of the posterior compartment, observation of the relative positioning of the uterus and ovaries, and the uterine sliding sign maneuver to enhance the detection of endometriosis. These additional maneuvers can typically be completed in less than five minutes and have the potential to reduce diagnostic delays for at-risk patients. Direct and indirect observations of deep endometriosis should also be evaluated during the exam, with results reported using four categories to guide patient management.
The SRU’s consensus statement on routine pelvic ultrasound for endometriosis aims to improve the detection of deep endometriosis even during the initial ultrasound without requiring special patient preparation or significant additional time. While these guidelines are intended for symptomatic patients at typical risk for endometriosis, patients with higher risk factors or specific clinical indications may benefit from advanced endometriosis imaging. Validation studies will be necessary to confirm the accuracy and effectiveness of augmented pelvic ultrasound in clinical practice.
Overall, the expert consensus statement offers a comprehensive set of recommendations to enhance the diagnostic sensitivity for endometriosis on pelvic ultrasound. By increasing awareness, improving interpretation, and adding simple yet high-yield techniques for deep endometriosis detection, these guidelines have the potential to expedite diagnoses and improve patient outcomes for those affected by this challenging condition.
