Relationship Between Ultrasound Diagnosis, Symptoms and Pain Scale Score on Examination in Patients with Uterosacral Ligament Endometriosis

Background/Objectives: This study investigated patient pain descriptors for transvaginal ultrasound (TVS) diagnostic evaluation of endometriosis for uterosacral ligaments (USLs), including correlation between USL thickness and site-specific tenderness (SST). It further investigated if SST could positively assist diagnosing endometriosis on TVS. Methods: TVS images and SST pain descriptors were collected from 42 patients. SST was evaluated by applying sonopalpation during TVS. The images were presented to six observers for diagnosis based on established USL criteria. Following this, they were given the SST pain scores and asked to reevaluate their diagnosis to assess if the pain scores impacted their decision. Results: An independent t-test showed that the patients with an endometriosis history had higher pain scores overall (7.2 +/- 0.59) compared to the patients with no history (0.34 +/- 0.12), t (40) = 8.8673. Spearman's correlation showed a strong correlation to the pain scale score for clinical symptoms (r = 0.74), endometriosis diagnosis (r = 0.78), USL thickness (r = 0.74), and when USL nodules were identified (r = 0.70). Paired t-tests showed that the observers demonstrated a higher ability to correctly identify endometriosis with the pain scale information (33 +/- 8.83) as opposed to not having this information (29.67 +/- 6.31), which was a statistically significant change of 3.33, t (5) = 2.7735. Conclusions: Patients with an endometriosis history have significantly higher pain scores on TVS compared to patients with no endometriosis history. A strong correlation was shown between SST pain scores and patient symptoms, USL thickness, and USL nodules. Inclusion of SST alongside TVS imaging shows promise, with these results demonstrating a higher ability to diagnose endometriosis with additional SST pain scale information.