Ovarian Immobility at Transvaginal Ultrasound: An Important Sonographic Marker for Prediction of Need for Pelvic Sidewall Surgery in Women With Suspected Endometriosis

Objectives To determine whether ovarian fixation at transvaginal ultrasound (TVU) is a marker for a need for laparoscopic pelvic sidewall surgery (ie, ureterolysis or dissection of adhesions involving the pelvic sidewall). The relationship between ovarian immobility at TVU with respect to endometriosis staging using the revised American Fertility Society (r‐AFS) classification was also evaluated. Methods Retrospective diagnostic accuracy study was performed in a tertiary referral hospital and two private hospitals. Sixty‐six women with pelvic pain underwent detailed TVU preoperatively followed by laparoscopic endometriosis surgery. TVU ovarian mobility findings (ie, mobile versus fixed ovary) were compared to surgical findings, the need for laparoscopic pelvic sidewall surgery and r‐AFS score (I–IV). Results Complete ultrasound and surgical data were available for 66 of 77 (86%) women. Twenty‐six of 66 (40%) had isolated superficial peritoneal endometriosis, 15 of 66 (23%) had ovarian endometrioma (OE), 13 of 66 (20%) had pelvic deep endometriosis (DE). Twenty‐seven of 66 (41%) had ovarian fixation at TVU. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of ovarian fixation at TVU for the prediction of need for laparoscopic pelvic sidewall surgery was 71%, 61%, 86%, 85%, and 62%, respectively ( P = .0002). Ovarian fixation at TVU was significantly associated with the presence of ipsilateral OE, pouch of Douglas obliteration, pelvic DE nodules, and r‐AFS stage III/IV (moderate/severe) endometriosis (all P ‐values <.05). Conclusions Ovarian fixation at TVU appears to be a marker for moderate/severe endometriosis and the need for laparoscopic pelvic sidewall surgery. This sign may be a valuable “red flag” for identifying women at increased risk of requiring an advanced laparoscopic surgeon, and in turn, improve surgical planning.