Are sonographers the future ‘gold standard’ in the diagnosis of endometriosis?

Abstract Diagnosis of endometriosis has traditionally relied on laparoscopic surgery, which was considered the ‘gold standard’ diagnostic tool. This is not ideal as surgery carries risk, is expensive, is difficult to access, and disrupts patients work or education due to the recovery time needed. As such, imaging has been investigated as a potential method for non‐invasive diagnosis, with transvaginal ultrasound showing high diagnostic accuracy for ovarian endometriomas and deep endometriosis. The advances in imaging capability led to recent international guidelines suggesting laparoscopy is no longer the ‘gold‐standard’ for diagnosis and encouraging clinicians to utilise medical imaging as part of their diagnostic work‐up for endometriosis. Imaging is emerging as not only a tool for planning endometriosis surgery but increasingly as the first approach for initial diagnosis. Given that transvaginal ultrasound is the primary imaging modality for assessment of gynaecological conditions, it is inevitable that sonographers will have a significant future role in endometriosis diagnosis. This moves away from endometriosis diagnosis being the exclusive realm of laparoscopic surgeons and increasingly involves medical imaging specialists. This review article will describe the origins of endometriosis ultrasound and the current capabilities of transvaginal ultrasound in this field. The expectations of sonographers in this evolving space will be explored, as well as recent novel research findings to gain insight into what the future of endometriosis diagnosis with ultrasound may look like.