Validation study of nonsurgical diagnosis of endometriosis

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. Patient(s): 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 Measure(s): 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. Result(s): 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. Conclusion(s): Noninvasive tools may be used to identify women with ovarian, but not nonovarian endometriosis, with excellent agreement with surgical diagnosis.