Diagnosis of endometriosis in the 21st century.
Level 1 - systematic review of randomized trials
Systematic review of diagnostic accuracy studies (53 included publications).
PubMed 30905186 · doi:10.1080/13697137.2019.1578743
What was done
The authors conducted a systematic literature search across MEDLINE/PubMed, Cochrane, and Google Scholar to evaluate less invasive diagnostic methods for endometriosis, including imaging modalities, genetic tests, biomarkers, and microRNAs (miRNAs). A total of 53 publications contributed to the review.
What was found
Transvaginal ultrasound showed a sensitivity of 93% and a specificity of 96% for diagnosing endometrioma. In contrast, superficial/peritoneal endometriosis could not be detected with imaging methods. The abstract provides no quantitative diagnostic metrics (such as sensitivity, specificity, or AUC) for genetic tests, biomarkers, or miRNAs.
Why it matters
Endometriosis diagnosis is frequently delayed by 8 to 12 years due to reliance on invasive laparoscopy. Identifying validated non-invasive diagnostic tools or combinations could shorten diagnostic delays, though no single non-invasive test is currently sufficient across all disease phenotypes.
Limits
Numerical diagnostic accuracy metrics are reported only for transvaginal ultrasound in endometrioma, leaving performance data for biomarkers, genetic tests, and miRNAs unspecified in the abstract. Non-invasive imaging fails to detect superficial peritoneal lesions, and existing non-invasive tests require further research before routine clinical implementation.
Cited by
- supports The diagnostic gold standard for endometriosis is surgical confirmation because no laboratory test exists.