Abstract

Objectives: To update the 2021 International Society for Gynecologic Endoscopy (ISGE) recommendations for structured reporting of dynamic ultrasound findings in patients with suspected or known endometriosis, integrating recent technical and methodological advances and contemporary diagnostic evidence. Study design A multidisciplinary ISGE working group (sonologists, surgeons, radiologists, methodologists) performed a focused, non-systematic literature review (January 2015-September 2025), prioritizing prospective multicentre diagnostic accuracy studies, high-quality cohorts, systematic reviews and intersociety consensus statements. Draft items were derived from validated frameworks (International Deep Endometriosis Analysis, Morphological Uterus Sonographic Assessment, International Endometrial Tumor Analysis, International Ovarian Tumor Analysis) and the #Enzian classification, refined by a writing subgroup and scored iteratively using Delphi rounds. Evidence quality and recommendation strength were graded using the Grading of Recommendations Assessment, Development and Evaluation system.

Results: When performed by experienced operators, dynamic ultrasound shows high specificity and generally high sensitivity for ovarian endometriomas, many forms of deep endometriosis, and adenomyosis; sensitivity is more variable, particularly for parametrial involvement and small superficial peritoneal lesions. Structured, compartment-based reporting improved completeness and may increase concordance with intraoperative mapping compared with unstructured reports. The 2026 ISGE update expands the 2021 template with standardized superficial peritoneal descriptors, lateral compartment subdivision (parametrium, pelvic sidewall, pelvic nerve assessment) and detailed quantitative pelvic metrics. Optional advanced fields capture items supported by lower-quality or emerging evidence. Implementation recommendations include targeted training, Picture Archiving and Communication System integration, and staged adoption.

Conclusions: The 2026 ISGE structured ultrasound report provides a practical, surgically actionable template. Prospective multicentre validation and standardized training are priorities.