International Deep Endometriosis Analysis IDEA

Definition: Endometriosis is a prevalent gynecological condition affecting about 5% of women. It manifests as endometrial-like tissue found outside the uterus, impacting various pelvic organs including the ovaries, pelvic peritoneum, pouch of Douglas, rectum, rectosigmoid, rectovaginal septum, uterosacral ligaments, vagina, and urinary bladder.
Importance of Accurate Diagnosis: Proper identification of the sites and severity of endometriosis is crucial for developing effective treatment strategies. Non-invasive imaging is essential for accurately mapping endometriotic lesions.
Recommendation for Centers of Expertise: The World Endometriosis Society has advocated for specialized centers to manage complex cases effectively, necessitating an efficient system to triage and understand disease locations.

Transvaginal Sonography (TVS): TVS is established as the primary imaging modality for diagnosing pelvic endometriosis, particularly deep infiltrating endometriosis (DIE). However, detection rates vary widely, highlighting the need for standardized definitions and protocols.
Diagnostic Accuracy: Studies indicate that adding ultrasound examinations from skilled operators to history and pelvic exams increases diagnostic accuracy. Consistency in identifying and classifying anatomical structures via standardized terminology is necessary to improve accuracy across studies.

Objective: The IDEA consensus aims to standardize terminology, definitions, and measurement techniques for sonographic evaluation of various types of endometriosis, improving comparability across research and clinical settings.
Terminology Standardization: Establishing a common language will facilitate better communication regarding sonographic findings of endometriosis and improve research outcomes, enabling a more consistent approach to management and study design.

Panel Composition: The consensus was developed by a panel of experts, including clinicians, sonologists, and radiologists specializing in endometriosis evaluation and management. The consensus process involved discussions, drafts, and revisions until a consensus was achieved.
Clinical History and Examination: A thorough clinical history is critical for women suspected of having endometriosis, detailing factors such as symptoms, previous surgeries, and family history. A pelvic exam should follow the history and may reveal physical signs of endometriosis, such as tenderness.

Steps to Sonography:
1. Routine Examination of Uterus and Adnexa: Assessing mobility of the uterus and identifying signs of adenomyosis and endometriomas.
2. Assessment of Soft Markers: Looking for tenderness and the movement of the ovaries suggests the presence of endometriosis.
3. Sliding Sign Evaluation: Checking for movement of the bowel against the uterus helps in identifying the state of the pouch of Douglas (POD).
4. DIE Nodule Assessment: Systematic evaluation through transvaginal imaging, documenting nodules in different pelvic compartments.

Anterior Compartment: Includes examination of the urinary bladder, ureters, and associated structures. Bladder DIE primarily lies posteriorly near the bladder base and the dome.
Posterior Compartment: Identification of lesions in the uterosacral ligaments, posterior vaginal wall, and the anterior rectum.
- Significance of Rectovaginal Septum (RVS): Recognition of endometriosis in RVS is essential due to its clinical implications, requiring specific imaging techniques to diagnose accurately.

All endometriosis lesions should be quantified in three orthogonal planes (length, thickness, and width) to provide comprehensive data on their extent, which is vital for treatment planning.
Emphasizing the necessity of accurate measurement will enhance understanding of the severity and implications of the disease, aiding in better management.

TVS stands as the frontline approach for evaluating suspected endometriosis, demonstrating robust accuracy in diagnosing various forms, including ovarian and bowel endometriosis.
Developing a consistent imaging strategy backed by standard terminology will significantly enhance clinical practices and research efficacy, ultimately improving patient outcomes in endometriosis management. The consensus encourages widespread adoption of these standardized practices to unify global approaches to diagnosis and treatment.