Validation study of nonsurgical diagnosis of endometriosis

Brenda Eskenazi; Marcella Warner; Luigi Bonsignore; David Olive; Steven Samuels; Paolo Vercellini

doi:10.1016/s0015-0282(01)02736-4

Diagnostics Ultrasound

Validation study of nonsurgical diagnosis of endometriosis

Eskenazi B, Warner M, Bonsignore L, Olive D, Samuels S, Vercellini P

Published November 13, 2001 Fertility and Sterility, 76(5), 929-935

DOI 10.1016/s0015-0282(01)02736-4 PMID 11704113

RRM Academy Synopsis

Ultrasound and exam can predict ovarian endometriosis before surgery

Ultrasound and a pelvic exam reliably predicted ovarian endometriosis before surgery in 90 Italian women scheduled for pelvic operations. Other types were hard to predict. A second group of 120 women had similar results.

Key Findings

Of 90 women in the study sample, 37 had endometriosis at surgery: 21 ovarian and 16 nonovarian.
A positive ultrasound sorted 81% of women into the right group. Sensitivity was 0.57, specificity 0.98, positive predictive value 95% and negative predictive value 76%.
A positive pelvic examination sorted 74% of women into the right group. Reporting any symptom did so for 66%.
The decision tree placed every woman with ovarian endometriosis in the right group and put no other woman there. Of 16 women with nonovarian endometriosis, 6 (38%) were placed correctly.
In the test sample, the tree placed 85% of women with ovarian endometriosis correctly, and 4 (12%) of the nonovarian cases.

Interpretation

The authors built a decision tree from a prospective study at one Italian hospital. They then checked it against records from a second hospital. One gynecologist did every exam and ultrasound in the first group. The women were headed to surgery for pain, infertility, tubal ligation or pelvic masses. The authors apply the results to clinic-based populations. Symptoms alone sorted women only moderately well, and the authors state that in population-based studies pain and infertility are likely to have extremely low sensitivity.

RRM Context

RRM puts evaluation before treatment. This study measures how much of that evaluation can happen in the clinic before an operation is planned.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To determine whether the surgical diagnosis of endometriosis can be predicted using symptoms, signs, and ultrasound findings.

Design

Prospective study (study sample); retrospective record review (test sample).

Setting

Hospital of Desio (study sample) and Mangiagalli Hospital (test sample), Italy.

Patients

Ninety women scheduled to undergo laparoscopy or laparotomy (study sample); 120 women who underwent laparoscopy (test sample).

Intervention

The study sample group was interviewed before surgery about infertility and dysmenorrhea, dyspareunia, and noncyclic pelvic pain and each member had a pelvic examination and a transvaginal ultrasound. At surgery, endometriosis was noted. For the test sample, the same information was abstracted from medical records after laparoscopy.

Main Outcome Measures

The ability of symptoms, signs, and ultrasound to predict endometriosis at surgery. A classification tree was developed with the study sample and evaluated with the test sample.

Results

Ovarian endometriosis, but not nonovarian endometriosis, could be reliably predicted with noninvasive tools. Ultrasound and examination best predicted ovarian endometriosis, correctly classifying 100% of cases with no false positive diagnoses in the study sample. Similar results were found in the test sample.

Conclusions

Noninvasive tools may be used to identify women with ovarian, but not nonovarian endometriosis, with excellent agreement with surgical diagnosis.

Read the guide

Endometriosis Explained: Diagnosis, Excision Surgery, and the RRM Approach

Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.

22 min read

Topics

Diagnostics › Ultrasound › Transvaginal Ultrasound · Endometriosis › Diagnosis › Imaging · General Gynecology › Pelvic Pain › Chronic Pelvic Pain

Brenda Eskenazi, Marcella Warner, Luigi Bonsignore, David Olive, Steven Samuels, Paolo Vercellini

B Eskenazi, M Warner, L Bonsignore, Dave Olive, D Olive, Steve Samuels, S Samuels, P Vercellini

PMID 11704113 11704113 DOI 10.1016/s0015-0282(01)02736-4 10.1016/s0015-0282(01)02736-4 Eskenazi et al. 2001, Eskenazi 2001

Keywords

Adult, Endometriosis/diagnosis/physiopathology, Female, Humans, Middle Aged, Ovarian Diseases/diagnosis, Physical Examination, Prospective Studies, Retrospective Studies, Ultrasonography

Validation study of nonsurgical diagnosis of endometriosis

Ultrasound and exam can predict ovarian endometriosis before surgery

Key Findings

Interpretation

RRM Context

Abstract

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Topics

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Keywords