New Preoperative Adhesion Scoring System Using Transvaginal Ultrasonography for Endometriosis

Study Objective To investigate the accuracy and clinical value of a new adhesion scoring system using transvaginal ultrasonography for endometriosis. Design Prospective observational study. Setting Nippon medical school hospital, Tokyo, Japan. Patients or Participants 131 patients with endometriosis who underwent surgery at Nippon medical school Hospital. Interventions Before surgery, transvaginal ultrasonography and adhesion mapping were performed to determine the presence or absence of adhesions at 10 sites of the pelvis. Measurements and Main Results To determine the severity of pelvic adhesions, we developed an adhesion score (0-10). With the adhesion score, we assessed the effect of surgical adhesiolysis and evaluated the relationship between postoperative adhesions and infertility.Results: Of the 10 sites assessed for adhesions, the most frequent site of adhesions was the site between the left ovary and the uterus (70.5%). The overall sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy of adhesion mapping were 80.4%, 86.1%, 78.8%, 87.2%, 5.79, 0.23, and 83.9%, respectively. The adhesion score in this system was significantly correlated with the adhesion-related score in the r-ASRM classification (R2 = 0.734). Surgical adhesiolysis yielded only about 30% improvement postoperatively. The adhesion score in the non-in vitro fertilization (IVF) pregnancy group was significantly lower than that in the IVF pregnancy group (3.45 vs. 5.00; p = 0.04). Conclusion Our adhesion scoring system allowed an accurate prediction of the pelvic adhesion status and may potentially be an indicator of postoperative adhesions and infertility.