{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:08:38Z","timestamp":1791295718294,"version":"4.1.0"},"reference-count":37,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T00:00:00Z","timestamp":1685145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The actual prevalence of superficial endometriosis is not known. However, it is considered the most common subtype of endometriosis. The diagnosis of superficial endometriosis remains difficult. In fact, little is known about the ultrasound features of superficial endometriotic lesions. In this study, we aimed to describe the appearance of superficial endometriosis lesions at ultrasound examination, with laparoscopic and\/or histologic correlation. This is a prospective study on a series of 52 women with clinical suspicion of pelvic endometriosis who underwent preoperative transvaginal ultrasound and received a confirmed diagnosis of superficial endometriosis via laparoscopy. Women with ultrasound or laparoscopic findings of deep endometriosis were not included. We observed that superficial endometriotic lesions may appear as a solitary lesions, multiple separate lesions, and cluster lesions. The lesions may exhibit the presence of hypoechogenic associated tissue, hyperechoic foci, and\/or velamentous (filmy) adhesions. The lesion may be convex, protruding from the peritoneal surface, or it may appear as a concave defect in the peritoneum. Most lesions exhibited several features. We conclude that transvaginal ultrasound may be useful for diagnosing superficial endometriosis, as these lesions may exhibit different ultrasound features.<\/jats:p>","DOI":"10.3390\/diagnostics13111876","type":"journal-article","created":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T16:16:04Z","timestamp":1685204164000},"page":"1876","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Superficial Endometriosis at Ultrasound Examination\u2014A Diagnostic Criteria Proposal"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1271-0689","authenticated-orcid":false,"given":"Marcelo","family":"Pedrassani","sequence":"first","affiliation":[{"name":"CLINUS Ultrasound Clinic, Florian\u00f3polis 88015-200, Brazil"},{"name":"Department of Obstetrics and Gynecology, Hospital Maternidade Carmela Dutra and Hospital Baia Sul, Florian\u00f3polis 88015-270, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1359-7155","authenticated-orcid":false,"given":"Stefano","family":"Guerriero","sequence":"additional","affiliation":[{"name":"Centro Integrato di Procreazione Medicalmente Assistita e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria\u2014Policlinico Duilio Casula, Monserrato, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5095-6981","authenticated-orcid":false,"given":"Mar\u00eda \u00c1ngela","family":"Pascual","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Ajossa","sequence":"additional","affiliation":[{"name":"Centro Integrato di Procreazione Medicalmente Assistita e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria\u2014Policlinico Duilio Casula, Monserrato, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7682-3773","authenticated-orcid":false,"given":"Betlem","family":"Graupera","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1011-7301","authenticated-orcid":false,"given":"Mariachiara","family":"Pagliuca","sequence":"additional","affiliation":[{"name":"Centro Integrato di Procreazione Medicalmente Assistita e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria\u2014Policlinico Duilio Casula, Monserrato, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9rgio","family":"Podgaec","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05403-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esdras","family":"Camargos","sequence":"additional","affiliation":[{"name":"Clinic of Gynecological Surgery and Endometriosis at Hospital Maternidade Carmela Dutra and Hospital Baia Sul, Florian\u00f3polis 88015-270, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ygor","family":"Vieira de Oliveira","sequence":"additional","affiliation":[{"name":"Hospital Maternidade Carmela Dutra, Florian\u00f3polis 88015-270, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9700-0853","authenticated-orcid":false,"given":"Juan Luis","family":"Alc\u00e1zar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"26","author":"Zondervan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/S0015-0282(97)00191-X","article-title":"Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities","volume":"68","author":"Nisolle","year":"1997","journal-title":"Fertil. Steril."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"International Working Group of AAGL, ESGE, ESHRE and WES, Tomassetti, C., Johnson, N.P., Petrozza, J., Abrao, M.S., Einarsson, J.I., Horne, A.W., Lee, T.T.M., Missmer, S., and Vermeulen, N. (2021). An international terminology for endometriosis. Hum. Reprod. Open, 2021, hoab029.","DOI":"10.1093\/hropen\/hoab029"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1038\/s41572-018-0008-5","article-title":"Endometriosis","volume":"4","author":"Zondervan","year":"2018","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.gmit.2014.06.001","article-title":"Visible and occult microscopic lesions of endometriosis","volume":"3","author":"Khan","year":"2014","journal-title":"Gynecol. Min. Invasive Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2701","DOI":"10.1093\/humrep\/deaa249","article-title":"Superficial peritoneal endometriotic lesions are histologically diverse and rarely demonstrate menstrual cycle synchronicity with matched eutopic endometrium","volume":"35","author":"Colgrave","year":"2020","journal-title":"Hum. Reprod."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Amro, B., Ramirez Aristondo, M.E., Alsuwaidi, S., Almaamari, B., Hakim, Z., Tahlak, M., Wattiez, A., and Koninckx, P.R. (2022). New Understanding of Diagnosis, Treatment and Prevention of Endometriosis. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19116725"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.bpobgyn.2020.08.005","article-title":"The epidemiology of endometriosis is poorly known as the pathophysiology and diagnosis are unclear","volume":"71","author":"Koninckx","year":"2021","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1111\/1471-0528.15894","article-title":"Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: Time for a rethink?","volume":"126","author":"Horne","year":"2019","journal-title":"BJOG"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s43032-019-00028-1","article-title":"Superficial Peritoneal Endometriosis: Clinical Characteristics of 203 Confirmed Cases and 1292 Endometriosis-Free Controls","volume":"27","author":"Reis","year":"2020","journal-title":"Reprod. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.jpag.2020.07.011","article-title":"The Prevalence of Endometriosis in Adolescents with Pelvic Pain: A Systematic Review","volume":"33","author":"Hirsch","year":"2020","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"hoac009","DOI":"10.1093\/hropen\/hoac009","article-title":"ESHRE guideline: Endometriosis","volume":"2022","author":"Becker","year":"2022","journal-title":"Hum. Reprod. Open."},{"key":"ref_13","first-page":"CD012179","article-title":"Blood biomarkers for the non-invasive diagnosis of endometriosis","volume":"2","author":"Nisenblat","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_14","first-page":"CD009591","article-title":"Imaging modalities for the non-invasive diagnosis of endometriosis","volume":"2","author":"Nisenblat","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1002\/uog.18961","article-title":"Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: Systematic review and meta-analysis","volume":"51","author":"Guerriero","year":"2018","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Noventa, M., Scioscia, M., Schincariol, M., Cavallin, F., Pontrelli, G., Virgilio, B., Vitale, S.G., Lagan\u00e0, A.S., Dessole, F., and Cosmi, E. (2019). Imaging Modalities for Diagnosis of Deep Pelvic Endometriosis: Comparison between Trans-Vaginal Sonography, Rectal Endoscopy Sonography and Magnetic Resonance Imaging. A Head-to-Head Meta-Analysis. Diagnostics, 9.","DOI":"10.3390\/diagnostics9040225"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/ajo.12911","article-title":"Multicentre retrospective study to assess diagnostic accuracy of ultrasound for superficial endometriosis-Are we any closer?","volume":"59","author":"Chowdary","year":"2019","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.ejogrb.2020.08.051","article-title":"SonoPODography: A new diagnostic technique for visualizing superficial endometriosis","volume":"254","author":"Leonardi","year":"2020","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1002\/uog.15955","article-title":"Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: A consensus opinion from the International Deep Endometriosis Analysis (IDEA) group","volume":"48","author":"Guerriero","year":"2016","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Revised American Society for Reproductive Medicine (1997). Classification of endometriosis: 1996. Fertil. Steril., 67, 817\u2013821.","DOI":"10.1016\/S0015-0282(97)81391-X"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/00001703-199406000-00006","article-title":"Treatment of deeply infiltrating endometriosis","volume":"6","author":"Koninckx","year":"1994","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2698","DOI":"10.1093\/humrep\/dei135","article-title":"ESHRE guideline for the diagnosis and treatment of endometriosis","volume":"20","author":"Kennedy","year":"2005","journal-title":"Hum. Reprod."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/S0015-0282(02)03337-X","article-title":"Location, color, size, depth, and volume may predict endometriosis in lesions resected at surgery","volume":"78","author":"Stratton","year":"2002","journal-title":"Fertil. Steril."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1067\/mob.2003.426","article-title":"Endometriosis: Correlation between histologic and visual findings at laparoscopy","volume":"188","author":"Martin","year":"2003","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1067\/mob.2001.115747","article-title":"Endometriosis: Correlation between histologic and visual findings at laparoscopy","volume":"184","author":"Walter","year":"2001","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/S0015-0282(16)59767-2","article-title":"Subtle appearance of pelvic endometriosis","volume":"49","author":"Stripling","year":"1988","journal-title":"Fertil. Steril."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1111\/j.1471-0528.2004.00433.x","article-title":"Accuracy of laparoscopy in the diagnosis of endometriosis: A systematic quantitative review","volume":"111","author":"Wykes","year":"2004","journal-title":"Br. J. Obstet. Gynaecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1016\/S0015-0282(16)59611-3","article-title":"Age-related evolution in color appearance of endometriosis","volume":"48","author":"Redwine","year":"1987","journal-title":"Fertil. Steril."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1080\/01443615.2019.1603217","article-title":"Diagnostic delay for superficial and deep endometriosis in the United Kingdom","volume":"40","author":"Ghai","year":"2020","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_30","first-page":"270","article-title":"Peritoneal pockets and endometriosis. Confirmation of an important relationship, with further observations","volume":"34","author":"Redwine","year":"1989","journal-title":"J. Reprod. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.ejogrb.2019.01.018","article-title":"The association between ultrasound-based \u2018soft markers\u2019 and endometriosis type\/location: A prospective observational study","volume":"234","author":"Reid","year":"2019","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"715","DOI":"10.3109\/01443615.2013.821971","article-title":"Endovaginal ultrasound-assisted pain mapping in endometriosis and chronic pelvic pain","volume":"33","author":"Yong","year":"2013","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1177\/2284026518767259","article-title":"Poor sensitivity of transvaginal ultrasound markers in diagnosis of superficial endometriosis of the uterosacral ligaments","volume":"10","author":"Robinson","year":"2018","journal-title":"J. Endometr. Pelvic Pain Disord."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"E5","DOI":"10.1111\/ajo.13131","article-title":"Transvaginal ultrasonography in superficial endometriosis","volume":"60","author":"Guerriero","year":"2020","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1097\/GCO.0000000000000812","article-title":"Effectiveness of ultrasound for endometriosis diagnosis","volume":"34","author":"Uzuner","year":"2022","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3301","DOI":"10.1002\/jum.15022","article-title":"A Novel Ultrasound Technique Called Saline Infusion SonoPODography to Visualize and Understand the Pouch of Douglas and Posterior Compartment Contents: A Feasibility Study","volume":"38","author":"Leonardi","year":"2019","journal-title":"J. Ultrasound Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jmig.2005.01.014","article-title":"Sonography and MR imaging for the assessment of deep pelvic endometriosis","volume":"12","author":"Bazot","year":"2005","journal-title":"J. Minim. Invasive Gynecol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/11\/1876\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:43:25Z","timestamp":1760125405000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/11\/1876"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,27]]},"references-count":37,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["diagnostics13111876"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13111876","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,27]]}}}