For many women, an endometriosis diagnosis is a relief. There’s now an explanation for years of agonizing pelvic pain and intense bleeding. Finally, a reason why she can’t get pregnant. Experts around the world are turning to ultrasound to find more timely answers. You can improve your capabilities by following a systematic approach to sonography—a step-by-step guide developed specifically for scanning patients with suspected endometriosis.

While endometriosis is quite common, it often goes undiagnosed. The condition affects one in ten women, or 176 million people worldwide.¹ Women with endometriosis wait an average of 7.5 years from the onset of symptoms to their eventual diagnosis.² And during that time, they typically go through seven to ten doctors. ³

While many physicians will recommend laparoscopy for a definitive diagnosis, surgery isn’t needed to begin treatment. Stefano Guerriero, M.D., Professor of Obstetrics and Gynecology at University of Cagliari, says laparoscopy is too invasive—and for his patients, it’s always ultrasound first.

“In my opinion, laparoscopy is not diagnostic—it’s therapeutic. We have to arrive at laparoscopy to treat the patient, not prove the diagnosis,” Guerriero stressed. “I am able to make an ultrasonic diagnosis for a majority of my cases, and I can start treating my patients with oral contraceptives. We only perform surgery if it’s a necessity.”

The ability for ultrasound to detect ovarian endometriosis and deep infiltrating endometriosis (bowel and non‐bowel) is well documented. According to research, transvaginal ultrasound scan with the addition of 3D has a sensitivity of 90 percent and a specificity of 95 percent in detecting the most common lesions of deep infiltrating endometriosis—the intestinal lesions.⁴

To educate physicians and researchers on how to identify endometriosis using ultrasound, The IDEA (International Deep Endometriosis Analysis Group) published a consensus opinion that outlines a systematic approach to examining the pelvis in women with suspected endometriosis.5 The protocol, which Dr. Guerriero helped create, also defines terms and measurements that describe the appearance of endometriosis on sonography.

“It’s a step-by-step approach. It’s very important to touch the organs and try to move them. That is fundamental to recognize the location of a lesion. We also push gently with the probe and interact with the patient to see if there is pain so we can obtain more information,” Guerriero explained.

For his practice, Guerriero relies on GE Healthcare’s Voluson™ ultrasound systems and routinely uses 3D imaging with OmniView. Another tool, Scan Assist, saves both measurement and annotation time, and is beneficial when utilizing these types of protocols. Guerriero also appreciates another Voluson feature, called VOCAL (Virtual Organ Computer-Aided Analysis). It enables volume calculations of irregularly shaped and complex anatomic structures, typically found in endometriosis imaging.

“They have a very high-quality, high-resolution probe. The quality of the image is so important—and with Voluson you have the capacity to move the probe, manipulate the organs, and maintain that good quality. If you can’t do that, you will lose information,” he stressed.

Technology is only one piece of the puzzle. For the protocol to be effective, more healthcare professionals will have to consider endometriosis as a possibility when a woman presents with chronic pelvic pain. The standardized approach must also be adopted universally—by everyone from gynecologists to general practitioners—in clinical and critical care settings.

“It has to be a consensus, but using the protocol can help put an end to the pain loop,” Guerriero said. “If you use the probe in the right manner, you stop a process. You can perform the entire examination and recognize there is something strange in the pelvis. You can stop this never-ending story.”