Preoperative Triple Pelvic Examination and Transvaginal Sonography: Diagnostic Predictive Value for Posterior Pelvic Deep Endometriosis

Abstract

Study Objective

To evaluate the predictive value of preoperative triple pelvic examination combined with transvaginal sonography (TVS) for posterior pelvic deep endometriosis (DE).

To evaluate the predictive value of preoperative triple pelvic examination combined with transvaginal sonography (TVS) for posterior pelvic deep endometriosis (DE).

Design

A prospective randomized controlled clinical study comparing preoperative and intraoperative Enzian scores.

A prospective randomized controlled clinical study comparing preoperative and intraoperative Enzian scores.

Setting

the Affiliated Hospital of Qingdao University.

the Affiliated Hospital of Qingdao University.

Patients

Eighty-five patients who underwent surgical treatment for endometriosis between June 2022 and December 2024.

Eighty-five patients who underwent surgical treatment for endometriosis between June 2022 and December 2024.

Interventions

Patients were randomized into two groups: Group A (n = 42) underwent TVS and triple pelvic examination separately and independently; Group B (n = 43) had TVS with prior provision of triple pelvic examination findings to sonographers. Preoperative Enzian scoring integrated clinical and TVS findings, and intraoperative Enzian scores were recorded.

Patients were randomized into two groups: Group A (n = 42) underwent TVS and triple pelvic examination separately and independently; Group B (n = 43) had TVS with prior provision of triple pelvic examination findings to sonographers. Preoperative Enzian scoring integrated clinical and TVS findings, and intraoperative Enzian scores were recorded.

Measurements and Main Results

In both Group A and Group B, the triple pelvic examination demonstrated significantly higher sensitivity than TVS for detecting utero-sacral ligament (USL) lesions (p = .002 and p = .049, respectively). In contrast, TVS was markedly superior to the triple pelvic examination in diagnosing DE lesions in the POD (p = .001 and p = .049, respectively). The combination of the triple pelvic examination and TVS improved both the sensitivity and accuracy for detecting deep pelvic endometriotic lesions, particularly for USL involvement (p = .002 and p = .049, respectively). For USL lesions, the sensitivity of TVS performed after clinical examination in Group B was 68.18%, which was significantly higher than the 38.10% achieved by TVS alone in Group A (p = .023).

In both Group A and Group B, the triple pelvic examination demonstrated significantly higher sensitivity than TVS for detecting utero-sacral ligament (USL) lesions (p = .002 and p = .049, respectively). In contrast, TVS was markedly superior to the triple pelvic examination in diagnosing DE lesions in the POD (p = .001 and p = .049, respectively). The combination of the triple pelvic examination and TVS improved both the sensitivity and accuracy for detecting deep pelvic endometriotic lesions, particularly for USL involvement (p = .002 and p = .049, respectively). For USL lesions, the sensitivity of TVS performed after clinical examination in Group B was 68.18%, which was significantly higher than the 38.10% achieved by TVS alone in Group A (p = .023).

Conclusion

Combining TVS with triple pelvic examination for preoperative Enzian scoring improves the sensitivity of posterior pelvic DE detection, with complementary advantages at different lesion sites.

Combining TVS with triple pelvic examination for preoperative Enzian scoring improves the sensitivity of posterior pelvic DE detection, with complementary advantages at different lesion sites.