THE ROLE OF PELVIC IMAGING IN THE DIAGNOSIS AND TREATMENT OF DEEP ENDOMETRIOSIS

Current consensus regarding diagnostic evaluation for deep endometriosis (DE) is lacking. Our objective is to investigate the practice patterns of gynecologic surgeons using pelvic imaging to evaluate and treat endometriosis, including the role of MRI. This survey study was sent to members of the Society of Reproductive Surgeons (SRS) after IRB approval. Data collected included physician demographics, practice patterns related to endometriosis, and pelvic imaging modalities used (including MRI) in perioperative planning. Responses were collected using multiple-choice items and modified Likert-type scales. Descriptive statistics were used to analyze quantitative data. The results are presented as preliminary data as data collection is currently ongoing. At the time of writing,20 participants have completed the online survey. 85% had training backgrounds in Reproductive Endocrinology & Infertility, 10% in general OB/GYN, and 5% in Minimally Invasive Gynecologic Surgery (MIGS). 75% and 25% were from academic practice settings and private practice settings, respectively. All respondents evaluate patients with endometriosis, and 50% (n=10) identify 1-5 cases per month of stage 3-4 endometriosis and DE, with 30% (n=6) and 10% (n=2) identifying >6 cases of each, respectively. Half of respondents (n=10) surgically manage the cases of DE they identify. The other half of respondents indicated they do not surgically manage DE, with (80% n=8) referring to MIGS for management. The majority (95%, n=19) order diagnostic imaging, with 65% (n=13) using ultrasound and 35% (n=7) using pelvic MRI as their primary imaging modality. Ninety percent (n=18) have MRI capability at their institutions, with only 50% (n=10) having MRI protocols specific for endometriosis. Fifty percent selected either “agree” or “strongly agree” that MRI imaging has helped with perioperative planning for patients suspected of DE. Among an initial survey of reproductive surgeons, although all respondents encounter DE, many refer to MIGS for surgical management. While almost all respondents order imaging to evaluate endometriosis, relatively fewer providers use MRI as their primary imaging modality and there is not broad use of endometriosis-specific protocols for DE.