The aim of this paper was to conduct a systematic review and meta-analysis to evaluate the clinical effectiveness and value based on ultrasound in the diagnosis of endometriosis in female athletes. Meta-analysis of observational studies showed that the two-dimensional sonographic criteria for endometriosis were significantly higher than the three-dimensional criteria (OR = 2.50, 95% CI = 1.61 to 3.79). Meta-analysis of randomized controlled trials showed that the risk of false negative was less than 20% when three dimensional criteria was used in comparison with no application (ROR=0.83, 95% CI=0.70 to 0.95). In addition, our analysis showed a significant difference in sensitivity between two- and three-dimensional criteria for endometriosis detection (P < 0.001) in female athletes. Also, our analysis showed that the sonographic diagnosis of endometriosis in female athletes was a significant contributing factor to surgical interventions. The overall clinical benefit of diagnosis by ultrasound was significant (OR = 9.22, 95% CI = 4.54 to 17.12).

From these findings, it can be concluded that the use of three-dimensional criteria in comparison with two-dimensional criteria leads to improved sensitivity and lower false negative rates, which are associated with a substantially reduced number of surgical intervention procedures. This finding is important in highlighting the possible beneficial clinical roles played by the use of three dimensional sonographic criteria in female athletes with endometriosis.