Objective To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) in detecting endometriosis in uterosacral ligament, rectovaginal diaphragm, pouch of Douglas and rectosigmoid colon before operation. Materials and Methods The literature about TVS diagnosis of deep invasive endometriosis (DIE) was systematically searched, including Chinese and English. The literature quality was evaluated according to QUADAS, and then the sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR) and diagnostic odds ratio (DOR) of different parts of endometriosis were evaluated by Meta-disc1.4 software. Results Totally 23 literatures were enrolled. The sensitivity of TVS in diagnosing uterosacral ligament, rectovaginal diaphragm, pouch of Douglas and rectosigmoid DIE was 0.78 (95%CI, 0.68-0.86), 0.55 (95%CI, 0.42-0.67), 0.89 (95%CI, 0.80-0.94) and 0.86 (95%CI, 0.74-0.93); The specificity was 0.92 (95%CI, 0.88-0.94), 0.98 (95%CI, 0.95-0.99), 0.96 (95%CI, 0.83-0.99) and 0.94 (95%CI, 0.90-0.97); +LR is 9.3 (95%CI, 6.9-12.5), 26.9 (95%CI, 11.6-62.0), 24.5 (95%CI, 4.8-123.9) and 14.9 (95%CI, 7.7-28.9); -LR is 0.24 (95%CI, 0.15-0.36), 0.46 (95%CI, 0.36-0.61), 0.11 (95%CI, 0.06-0.20) and 0.15 (95%CI, 0.07-0.29); DOR is 40 (95%CI, 24-66), 58 (95%CI, 24-141), 219 (95%CI, 46-1043) and 102 (95%CI, 29-360). The areas under SROC curve of four parts are 0.94 (95%CI, 0.91- 0.95), 0.88 (95%CI, 0.85- 0.91), 0.96 (95%CI, 0.94-0.98) and 0.97 (95%CI, 0.95-0.98) respectively. Conclusion The overall diagnostic performance of TVS for uterosacral ligament, rectovaginal diaphragm, pouch of Douglas, and rectosigmoid colon DIE is good and specific, and can be used as a routine diagnostic method for DIE.