AN ULTRASOUND DEPARTMENT’S DRIVE TO IMPROVE AWARENESS AND DIAGNOSIS OF ENDOMETRIOSIS
By Joy Oparanozie, University Hospitals Plymouth NHS Trust
Objective:
Endometriosis is a debilitating disease affecting one in ten women of reproductive age. It accounts for 50% of female infertility, has a poor detection rate, and an average time to diagnosis of 7-10 years.
Endometriosis is recognized by WHO, many health bodies and governments as a condition that urgently requires better diagnosis and timely treatment. Recently it has been queried as a neuroimmune condition, and treatments based on this theory show promising potential.
There has been emerging information on recognising the symptoms and ultrasound features of endometriosis, and recently the European Society of Human Reproduction and Embryology validated ultrasound as a key tool in diagnosis of endometriosis.
Our department was keen to learn more about ultrasound detection, particularly of deep infiltrating endometriosis.
Method:
Over the last 6 months the department has had 3 dedicated CPD sessions focused on endometriosis, along with on-going individual hands-on training and case review. We are concentrating on awareness of symptoms and appropriate clinical history, as well as ultrasound signs including the “question mark sign ”, presence of deep infiltrating endometriotic nodules, and use of ultrasound techniques including sonopalpation to assess for endometriotic adhesions within the pelvis.
Results:
The results so far show a significant increase in the detection of endometriosis, and especially of deep infiltrating endometriosis. As an ongoing project we continue to review the rate of detection, and where possible, confirmation of diagnosis by MRI, laparoscopy and/or treatment success. We noticed that pathology was often focused in the retro-uterine pouch and this has prompted us to include the ‘slide-sign’ in the gynae protocol.
Conclusion:
Focused teaching and support of sonographers has resulted in an increased awareness and detection of endometriosis in our department; we are continuing to collect data to quantify this increase.
