Optimizing endometriosis diagnosis and mapping: The important role of advanced transvaginal ultrasound

Endometriosis is estimated to affect 5%-10% of women of reproductive age, making timely diagnosis essential for initiating treatment, alleviating symptoms, and reducing the risk of disease progression. Unfortunately, the diagnostic delay in this disease is estimated to be approximately 10 years. The aim of this study is to present a case series of three patients assessed with both imaging modalities for endometriosis diagnosis and mapping, advanced transvaginal ultrasound (ATVUS) and magnetic resonance imaging (MRI). The findings obtained by performing the ATVUS imaging study protocol with different pelvic compartments according to the International Deep Endometriosis Analysis (IDEA) consensus are described and contrasted with those for MRI, along with their correlation to surgical and histological findings. A single gynecologist with specialized training in ATVUS performed a systematic pelvic evaluation in patients with clinical suspicion of endometriosis. The physician performed the anatomo-sonographic assessments described by the IDEA consensus. A retrospective analysis of the three cases was performed comparing both imaging modalities and surgical and histological findings. It was demonstrated in this case series that endometriosis is detectable in distinct pelvic compartments by ATVUS, with results comparable to MRI, while offering the benefits of lower cost and widespread accessibility. In contrast, individuals, insurance companies, and healthcare systems in some countries might be unable or unwilling to cover MRI costs for endometriosis diagnosis or presurgical mapping. In conclusion, given the high prevalence of endometriosis, mastering ATVUS is essential. Future studies should aim to robustly evaluate the role of ATVUS alongside other imaging modalities, including MRI, to maximize diagnostic accuracy.