Ultrasound in deep endometriosis: A narrative review

Background Over the past decade, transvaginal ultrasound (TVUS) has revolutionized the diagnosis of deep endometriosis. We can now accurately describe and evaluate lesions in multiple compartments of the pelvis, increasing diagnostic capacity without the need for initial laparoscopy. Recent consensus and publications support the new and growing evidence for this technique. Research into deep endometriosis has increased substantially and new diagnostic evidence is now available. Objectives The aim of this article is to review the state of the art in ultrasound diagnosis of deep endometriosis. Methods We performed a detailed search of the PubMed database to identify eligible primary studies. We included English-language publications with the following terms: "endometriosis" AND "deep" AND "ultrasound" AND "transvaginal". Studies focusing on ultrasound in deep endometriosis were included, we selected them based on title reading, then narrowed the selection by reading the abstract. -We excluded publications that didn't use TVUS as one of the main techniques to evaluate deep endometriosis. Results 243 studies were identified and selected as described above, resulting in a total of 73 studies included in this review. Conclusions and outlook Our understanding of deep endometriosis has evolved over the past decade. Efforts have been made to reduce the diagnostic delay in this common disease, particularly with the increased use of imaging, especially transvaginal ultrasound, as a first-line diagnostic modality because of its availability, good test performance, cost-effectiveness, and low environmental impact compared to other imaging modalities. This statement is supported by recent publications and guidelines from some medical societies. Advances in technology, equipment and research have allowed us to identify additional compartments involved, including the parametrium. The progress made in recent years offers hope for earlier detection and improved management of patients with suspected endometriosis who suffer not only from pelvic pain but also from infertility.