ULTRASOUND DIAGNOSTICS OF RETROCERVICAL ENDOMETRIOSIS

Background: Endometriosis is one of the major problems in current gynecology due to steady increase of its incidence, involvement of young females, high frequency of infertility and difficulties with diagnostics and treatment. Confirmation of diagnosis of advanced endometriosis is still within the competence of research centers and big federal treatment establishments.

Aim: To improve ultrasound diagnostics and to develop an algorithm of assessment in retrocervical endometriosis.

Materials and methods: Seventy two females were assessed laparoscopically due to a gynecology disorder or infertility. Based on intraoperational data and results of pathomorphological assessments, two groups were formed: group 1 (control group, n = 26) comprised patients in reproductive age who had been admitted for elective surgery due to a gynecological disorder. Group 2 (main group, n = 46) included patients with various types of endometriosis. Patients from group 2 were divided into 3 subgroups: 2а (n = 17) – with superficial forms of external genital endometriosis; 2b (n = 18) – with endometrioid cysts; 2c (n = 11) – with deep infiltrative types of endometriosis.

Results: Patients with superficial external genital endometriosis were characterized by positive symptom of “folding” (“freezing”) of posterior uterine surface and of the walls of adjacent intestine. In endometriosis of posterior surface of cervix uteri, the diagnosis made by an ultrasound assessmentin 100% matched the diagnosis set during surgery, whereas if sacrouterine ligaments were involved, the diagnostic match was only 3%. In the group of patients with endometrioid cysts, in most of cases the cysts had specific ultrasound signs; coincidence of an ultrasound and a morphological diagnosis was seen in 98% of cases. Most cases of deep infiltrative endometriosis showed involvement of sacrouterine ligaments (72%) and of parametrium (81%). There was a positive folding sign and a “Indian headdress symptom”. Retrocervical endometriosis was characterized by involvement of adjacent organs, such as rectum and rectosigmoideal flexion of the colon, vaginal walls, vaginorectal septum, parametrium, as well as obstructive uretheral adhesions with a pyeloectasy on the site of involvement. Diagnostic mismatches between the ultrasound method and surgery was seen in 4% of females. False positive results were found in 2% of cases. Based on the assessments performed, an original algorithm of ultrasound diagnostics of endometriosis is proposed.

Conclusion: Ultrasound assessment has a proven diagnostic value in retrocervical endometriosis.