Systematic, noninvasive endometriosis diagnosis in transvaginal sonography by the Swiss Society of Ultrasound in Medicine

Abstract

We present a new systematic, comprehensive, checklist-based sonographic assessment of endometriosis in the female true pelvis. Emphasis is placed on practical skills teaching. The newly introduced White Sliding Line (WSL) is the core structure. The WSL separates five compartments (anterior, central, posterior, and lateral right and left) containing dedicated endometriosis signs of mobility and morphology to be checked. This approach relies on the 2016 IDEA Consensus and further developments. It directly connects to the 2021 #ENZIAN Classification Standard. In practice, evaluation follows the proposed checklist in all compartments, judging first sliding mobility between organs and structures in a highly dynamic investigation. A rigorous search for deep endometriosis (DE) is then performed. We treat adhesions due to their great clinical importance and possible, reliable diagnosis by TVS as the fifth endometriosis unit, next to endometrioma, DE, adenomyosis, and superficial endometriosis. Including superficial (peritoneal) endometriosis is a future goal.

Zusammenfassung

Wir präsentieren eine systematische, umfassende, auf einer Checkliste basierende sonografische Abklärung der Endometriose im weiblichen kleinen Becken. Das Übermitteln praktischer Fähigkeiten stellt einen Schwerpunkt dar. Der neu eingeführten White Sliding Line (WSL) kommt dabei eine Schlüsselrolle zu. Die WSL ermöglicht die Einteilung in 5 Kompartimente (anterior, zentral, posterior und lateral rechts und links). Diese enthalten dedizierte Endometriose-Zeichen zur Mobilität und Morphologie. Die vorgeschlagene Systematik beruht auf dem IDEA-Konsensus von 2016 und dessen Erweiterungen. Sie leitet direkt in die #Enzian-Klassifikation von 2021 über. In der Praxis wird gemäß der Checkliste in einer betont dynamischen Untersuchung nach reduziertem oder aufgehobenem Sliding zwischen Organen und Strukturen gefahndet, gefolgt von einer rigorosen Suche nach tiefen Endometriose-Läsionen. Die große klinische Bedeutung der Adhäsionen und ihre zuverlässige sonografische Beurteilbarkeit lässt uns diese als 5. Entität der Endometriose behandeln, nebst Endometriomen, tiefer Endometriose, Adenomyose und oberflächlicher Endometriose. In Zukunft soll möglichst auch die oberflächliche (peritoneale) Endometriose in die Systematik aufgenommen werden.

Keywords

endometriosis - ultrasound - transvaginal - sonography - classification

Publication History

Received: 01 February 2024

Accepted: 16 February 2024

Article published online:
24 May 2024

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