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Assess 'soft markers' with transvaginal ultrasound: chronic pelvic pain.(News)
PARIS -- Assessment of "soft markers" of pelvic pathology greatly enhances the diagnostic potential of transvaginal ultrasound in women with chronic pelvic pain, Dr. Emeka Okaro said at the 13th World Congress on Ultrasound in Obstetrics and Gynecology.
Laparoscopy is currently the standard for assessing chronic pelvic pain, which affects approximately 15% of adult women and accounts for 10% of all gynecology visits. However, laparoscopy is expensive, carries a complication rate of about 3/1,000 cases, and fails to detect a cause of the pain in 40% of cases, said Dr. Okaro of St. George's Hospital, London.
Transvaginal sonography (TVS) is cheaper and less invasive but has been considered far less sensitive in detecting pelvic pathology, such as endometriosis or pelvic adhesions. In one study, 50% of patients with a "normal" TVS and vaginal exam were found to have abnormalities on laparoscopy (J. Reprod. Med. 40[7]:500-02, 1995).
That and other studies, however, have used TVS to look for only structural abnormalities, or so-called "hard markers," and not the "soft signs" of ovarian mobility and site-specific tenderness. Adding those elements to the TVS evaluation improves both the positive and negative predictive value for pelvic pathology and could potentially reduce the need for unnecessary laparoscopy, Dr. Okaro said at the congress, sponsored by the International Society of Ultrasound in Obstetrics and Gynecology.
In the first of three prospective studies, 120 consecutive patients (mean age 31) with chronic pelvic pain (duration 45 months) were scanned via TVS 1-2 weeks before diagnostic laparoscopy. Besides looking for pathology, the operator also used the vaginal probe to assess ovarian mobility (freely mobile vs. fixed) and site-specific tenderness, using a visual analog ...
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Source: HighBeam Research, Assess 'soft markers' with transvaginal ultrasound: chronic pelvic...