{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:57:31Z","timestamp":1790686651280,"version":"4.1.0"},"reference-count":16,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endometriosis is a chronic, inflammatory condition associated with pelvic pain, subfertility, and reduced quality of life. Advances in enhanced transvaginal ultrasound (eTVUS), including systematic compartment\u2010based scanning protocols and improved operator training, have increased diagnostic accuracy, particularly for deep endometriosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate and critically reflect on the diagnostic performance of eTVUS during its implementation prior to the adoption of standardised scanning protocols. Using the #ENZIAN classification system, the diagnostic performance of eTVUS was assessed by comparing ultrasound findings with laparoscopic visualisation as the reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective observational study of patients with suspected endometriosis who underwent preoperative eTVUS and subsequent laparoscopy between January 2015 and January 2024 at a single tertiary hospital. Ultrasound and surgical findings were mapped to #ENZIAN compartments and grades. Agreement and diagnostic metrics were calculated using laparoscopy as the reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 221 patients with paired ultrasound and laparoscopy, adnexal endometriomas were detected with a sensitivity of 81.4% and specificity of 84.1%. Tubo\u2010ovarian complex disease demonstrated a sensitivity of 72.9% and specificity of 68.8%. Sensitivity for deep endometriosis was lower, with specificity for detection depending on anatomical location varying from 83%\u201395%. Bladder involvement had a PPV of 83.3% and NPV of 94.8%; ureteric disease had a PPV of 0% and NPV of ~100%. Peritoneal disease was rarely identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>eTVUS demonstrated high diagnostic accuracy for ovarian endometriomas, moderate performance for bowel involvement, and low sensitivity for peritoneal disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ajo.70183","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:15:03Z","timestamp":1790684103000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transvaginal Ultrasound for Endometriosis: Learning From a Decade of Diagnostic Challenges Through a Retrospective Observational Cohort Study"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3643-1174","authenticated-orcid":false,"given":"Candice","family":"Dry","sequence":"first","affiliation":[{"name":"King Edward Memorial Hospital Women and Newborn Health Service  Perth Australia"},{"name":"Division of Obstetrics and Gynaecology The University of Western Australia  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4354-8987","authenticated-orcid":false,"given":"Charlotte","family":"Moss","sequence":"additional","affiliation":[{"name":"King Edward Memorial Hospital Women and Newborn Health Service  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2933-0615","authenticated-orcid":false,"given":"Elizabeth","family":"Nathan","sequence":"additional","affiliation":[{"name":"King Edward Memorial Hospital Women and Newborn Health Service  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8241-6162","authenticated-orcid":false,"given":"Michelle K.","family":"Pedretti","sequence":"additional","affiliation":[{"name":"King Edward Memorial Hospital Women and Newborn Health Service  Perth Australia"},{"name":"Division of Obstetrics and Gynaecology The University of Western Australia  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6906-588X","authenticated-orcid":false,"given":"Glen","family":"Lo","sequence":"additional","affiliation":[{"name":"King Edward Memorial Hospital Women and Newborn Health Service  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8548-1226","authenticated-orcid":false,"given":"Phillipa","family":"Robertson","sequence":"additional","affiliation":[{"name":"King Edward Memorial Hospital Women and Newborn Health Service  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7242-0934","authenticated-orcid":false,"given":"Bernadette","family":"Mcelhinney","sequence":"additional","affiliation":[{"name":"King Edward Memorial Hospital Women and Newborn Health Service  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4786-4354","authenticated-orcid":false,"given":"Emma R.","family":"Allanson","sequence":"additional","affiliation":[{"name":"King Edward Memorial Hospital Women and Newborn Health Service  Perth Australia"},{"name":"Division of Obstetrics and Gynaecology The University of Western Australia  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3928-3290","authenticated-orcid":false,"given":"Jan E.","family":"Dickinson","sequence":"additional","affiliation":[{"name":"King Edward Memorial Hospital Women and Newborn Health Service  Perth Australia"},{"name":"Division of Obstetrics and Gynaecology The University of Western Australia  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Australian Living Evidence Guideline: Endometriosis","author":"Royal Australian and New Zealand College of Obstetricians and Gynaecologists","year":"2023"},{"issue":"2","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1002\/uog.27558","article-title":"Addendum to Consensus Opinion From International Deep Endometriosis Analysis (IDEA) Group: Sonographic Evaluation of the Parametrium","volume":"64","author":"Guerriero S.","year":"2024","journal-title":"Ultrasound in Obstetrics & Gynecology"},{"key":"e_1_2_10_4_1","volume-title":"Endometriosis in Australia 2023","author":"Australian Institute of Health and Welfare","year":"2023"},{"issue":"1","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","DOI":"10.1007\/s13669-025-00424-2","article-title":"The Role of Ultrasound in the Evolving Landscape of Precision Imaging of Endometriosis","volume":"14","author":"Shetty R.","year":"2025","journal-title":"Current Obstetrics and Gynecology Reports"},{"issue":"3","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1002\/uog.24892","article-title":"Strengths and Limitations of Diagnostic Tools for Endometriosis and Relevance in Diagnostic Test Accuracy Research","volume":"60","author":"Pascoal E.","year":"2022","journal-title":"Ultrasound in Obstetrics & Gynecology"},{"key":"e_1_2_10_7_1","article-title":"Understanding Diagnostic Delay for Endometriosis: A Scoping Review","volume":"233","author":"Fryer J.","year":"2024","journal-title":"MedRxiv"},{"issue":"3","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","DOI":"10.1093\/hropen\/hoae029","article-title":"Non\u2010Invasive Imaging Techniques for Diagnosis of Pelvic Deep Endometriosis and Endometriosis Classification Systems: An International Consensus Statement","volume":"2024","author":"Condous G.","year":"2024","journal-title":"Human Reproduction Open"},{"key":"e_1_2_10_9_1","article-title":"Multidisciplinary Collaboration Advances Endometriosis Diagnosis and Treatment","author":"Wasson M.","year":"2025","journal-title":"Contemporary OB\/GYN"},{"issue":"2","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.fertnstert.2023.12.008","article-title":"Noninvasive Diagnostic Imaging for Endometriosis Part 1: A Systematic Review of Recent Developments in Ultrasound, Combination Imaging, and Artificial Intelligence","volume":"121","author":"Avery J. C.","year":"2024","journal-title":"Fertility and Sterility"},{"key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.bpobgyn.2020.11.004","article-title":"Classification of Deep Endometriosis (DE) Including Bowel Endometriosis: From r\u2010ASRM to# Enzian\u2010Classification","volume":"71","author":"Keckstein J.","year":"2021","journal-title":"Best Practice & Research. Clinical Obstetrics & Gynaecology"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.21037\/gpm-21-38","article-title":"The# Enzian Classification for the Diagnosis and Surgery of Endometriosis: A Narrative Review","volume":"4","author":"Keckstein J.","year":"2021","journal-title":"Gynecology and Pelvic Medicine"},{"issue":"19","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm13196005","article-title":"Concordance Between Preoperative #ENZIANi Score and Postoperative #ENZIANs Score Classification\u2010Why Do we Choose #ENZIAN and How Does It Impact the Future Classification Trend?","volume":"13","author":"Borowiec Z.","year":"2024","journal-title":"Journal of Clinical Medicine"},{"issue":"253","key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.ejogrb.2020.08.019","article-title":"Relationship Between Adenomyosis and Endometriosis; Different Phenotypes of a Single Disease?","volume":"1","author":"Maruyama S.","year":"2020","journal-title":"European Journal of Obstetrics, Gynecology, and Reproductive Biology"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap Consortium: Building an International Community of Software Platform Partners","volume":"95","author":"Harris P. A.","year":"2019","journal-title":"Journal of Biomedical Informatics"},{"issue":"2","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research Electronic Data Capture (REDCap) \u2013 a Metadata\u2010Driven Methodology and Workflow Process for Providing Translational Research Informatics Support","volume":"42","author":"Harris P. A.","year":"2009","journal-title":"Journal of Biomedical Informatics"},{"key":"e_1_2_10_17_1","unstructured":"National Health and Medical Research Council \u201cNational statement on ethical conduct in human research 2023\u201d."}],"container-title":["Australian and New Zealand Journal of Obstetrics and Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ajo.70183","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ajo.70183","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ajo.70183","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:15:08Z","timestamp":1790684108000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/ajo.70183"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":16,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/ajo.70183"],"URL":"https:\/\/doi.org\/10.1111\/ajo.70183","archive":["Portico"],"relation":{},"ISSN":["0004-8666","1479-828X"],"issn-type":[{"value":"0004-8666","type":"print"},{"value":"1479-828X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"assertion":[{"value":"2026-03-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70183"}}