B. Shakeri

EP26.03: Prediction of pouch of Douglas obliteration by analysing offline ultrasound and laparoscopic videosets: a diagnostic accuracy and interobserver study

follow-up. Patient was discharged stable. Ultrasound performed six months later noted a left ovarian cyst with low-level echoes. On follow-up, she was noted to have recovered completely and a scan performed a year later did not demonstrate any abnormalities in the pelvis. Conclusion: Patient was virgo intacta. Transrectal scan was attempted but unsuccessful. Transabdominal ultrasound was restricted by body habitus, hence resulting in suboptimum demonstration of the dermoid.

P18.02: Prevalence of negative 'sliding sign' in low-risk population: a feasibility study

Objectives: To investigate whether or not an ovarian endometrioma detected by ultrasound was associated with other appearances of pelvic endometriosis such as adhesions and/or deep infiltrating endometriosis (DIE) in order to improve the management of patients with pelvic pain or infertility. Methods: This is an observational retrospective study including a group of women (n=255) with at least an ovarian endometrioma (at least diameter of ≥ 20 mm) detected by transvaginal ultrasound (TVS). Patients with previous pelvic surgery and without symptoms were excluded. Other associated sonographic signs of pelvic endometriosis such as adhesions, tubal pathology, adenomyosis and DIE were recorded according to a detailed TVS mapping of pelvic endometriosis. Subsequently a group of women (n=50) underwent laparoscopic treatment and during surgery a complete endometriosis mapping was assessed. Results: Mean age was 34.2 ± 6.6 years, mean endometriomas diameter was 40.0 ± 18.1mm, bilateral endometriomas were observed in 65patients (25.5%). Of the 255 patients 50 underwent laparoscopic surgery due to severe symptoms whereas 205 had indications to medical therapy or ART. At TVS 55 (21.5%) showed posterior rectal DIE and 93 (36.4%) a thickening of at least one uterosacral ligament. 186 patients (73%) showed adhesions and 134 (53%) showed ultrasonographic features of adenomyosis. Only 57 (22%) had a single isolated ovarian lesion with a mobile ovary and without any other ultrasound signs of pelvic endometrioma. No statistically significant differences were observed in the TVS mapping and histological confirmation. Conclusions: Ovarian endometrioma is a marker for pelvic endometriosis and is rarely isolated 44% patients with an endometrioma showed DIE. Adhesions and adenomyosis are associated to endometrioma in more than 50%. In a clinical context when there is an ovarian endometrioma an accurate TVS should investigate the extension of the disease to check for other endometriotic lesions in order to choose the most appropriate treatment to manage pain and infertility.

OP31.10: Performance of the transvaginal sonographic ‘sliding sign’ in prediction of pouch of Douglas obliteration: does this improve over time?

Methods: Two experienced observers performed a review of stored 2D and 3D sonographic examinations of 50 consecutive women with typical sonographic signs of adenomyosis according of the MUSA. 20 patients without any sonographic signs of myometrial pathology were used as control group. Each observer, independently and blinded to each other, evaluated the presence or absence and the severity of adenomyosis using a new score system. The score system evaluated ultrasonographic criteria for focal and diffuse adenomyosis, adenomyoma and for junctional zone (JZ). A score number from 1 to 4 were assigned to the extension and myometrial involvement of each type of adenomyotic lesions and for JZ alterations. Numerical score obtained was classified in three group: mild (ranged between 1 to 7), moderate (8-13) and severe (14-20). Results: With respect to interpretation of the presence or not of adenomyosis ultrasonographic findings, the agreement was perfect (Cohen kappa, K=1). Multiple rater agreements to classify the different features of adenomyosis (diffuse, focal adenomyoma and focal or diffuse alteration of JZ) ranged from good to almost perfect (Cohen k 0.678 – 0.953). According to numerical score the agreement for minimal, moderate and severe adenomyosis ranged from substantial to almost perfect (respectively Cohen k=1, K=0.94, K= 0.79). Conclusions: Our new score system to diagnose adenomyosis severity were reproducible and could be useful in clinical practice. The high percentage of agreement obtained in the JZ evaluation could improve the sensitivity of adenomyosis diagnosis. The ultrasonographic quantification of severity and the extension of adenomyosis in the myometrium could be helpful in correlation to the severity of symptoms but also for an emerging request of surgical treatment.

P18.04: Transvaginal ultrasound ( TVS) combined evaluation of pelvic sites of implants and the “sliding sign” to predict likelihood of rectal/rectosigmoid deep infiltrating endometriosis (DIE) at laparoscopy

M. Espada6, C. Lu1, S. Reid3, B. Shakeri5, N. Stamatopoulos4, G. Condous2 1Computer Science, Aberystwyth University, Aberystwyth, United Kingdom; 2Obstetrics and Gynecology, Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia; 3Nepean Hospital, Chiswick, NSW, Australia; 4Early Pregnancy & Advanced Endosurgery Unit, Nepean Hospital, Penrith, NSW, Australia; 5Obstetrics and Gynecology, Nepean Hospital, Penrith, NSW, Australia; 6Acute Gynecology Service, Sydney, Medical School Nepean, Eastwood, NSW, Australia

P23.01: Doppler colour scoring system using offline video analysis in women with an incomplete miscarriage: inter- and intraobserver reproducibility study

G.T. Leong7, C. Lu5, B.J. Mein6, M. Espada4, B. Shakeri4, B. Nadim4, S. Reid2, I. Casikar3, G. Condous1 1Obstetrics and Gynecology, Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia; 2Nepean Hospital, Chiswick, NSW, Australia; 3Early Pregnancy, Acute Gynecology and Advanced Endosurgery Unit, Nepean Hospital, Enu Plains, NSW, Australia; 4Obstetrics and Gynecology, Nepean Hospital, Penrith, NSW, Australia; 5Computer Science, Aberystwyth University, Aberystwyth, United Kingdom; 6Perinatal Ultrasound, Nepean Hospital, Kingswood, NSW, Australia; 7University of Sydney, Sydney, NSW, Australia

EP27.04: Cost-benefit analysis for the use of transvaginal ultrasound to avoid laparoscopy in women with minimal endometriosis disease.

Methods: A review was performed retrospective images between January 2011 and October 2015, obtaining 62 nodular bowel lesions of anterior layer of rectosigmoid. All patients were operated by laparoscopic technique (shaving:48, resection termino-terminal: 12 and discoidal resection: 2) for the same surgical equipment and histology for DIE was confirm. In each one of the nodule image was determinated the angle of infiltrating and rectal lesion volume. AIERN measurement was determinated with 3 points: the proximal it’s located at the midpoint of healthy muscle layer of the proximal rectosigmoid (1), the apex is located at the deepest point of the infiltrative lesion (2) and the distal end is at the midpoint of the lowermost healthy muscle layer (3) figure. Later the angule was calculated and determined using ROC curve point with more significant court relating with bowel resection. RENV was calculated with ellipse formula and the best point ROC curve related to bowel resection was determinated. Results: For AIERN was chosen an equal or lower angle of 97.69 ◦ as increased risk of bowel resection (81.82% sensitivity; 78.43% Specificity; LHR + 3.79;LHR 0.23;area under the curve 0.831 ; p 0.0006). For RENV was chosen an equal or greater volume of 2.6578 cm3 as increased risk of bowel resection (83.83%sensitivity; specificity 80.36%; LHR + 4,24; LHR 0.21;under the curve area 0.833; p <0.0001). Conclusions: Sonographic markers RENV and AIERN are useful for predicting rectal lesions with possible rectal stenosis and subsequent bowel resection.