Endometriosis other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Joseph Nasr, M.D.[2], Aravind Kuchkuntla, M.B.B.S[3]

Overview

Diagnostic laparoscopy is the gold standard test to assess the severity and extent of the endometriosis.

Other Diagnostic Studies

Diagnostic Laparoscopy

  • Diagnostic laparoscopy is the gold standard for the diagnosis of endometriosis.[1]
    • Histologic confirmation of endometriosis (biopsy of suspected lesions) is the criterion standard for diagnosis.[2]
  • Diagnostic laparoscopy is useful for the assessment of the extent of the disease.
  • A scoring system was developed based on the extent of the disease to calculate the Endometriosis Fertility Index. It correlates disease severity to having a successful conception.
  • Multiple guidelines recommend a presumed diagnosis based on symptoms supported by physical examination and pelvic imaging (ultrasound and/or MRI), even though no validated diagnostic criteria exist.[2][3]
  • If lesions are suspected in the vagina, umbilicus, or abdominal surgical scars, referral to a gynecologist for consideration of biopsy is recommended.[2]

Diagnostic approach commonly begins with transvaginal pelvic ultrasound.[2][3][4]

If deep, ovarian, or extrapelvic endometriosis is suspected and imaging is negative or incomplete, consider MRI (if not previously performed) or augmented pelvic ultrasound if available.[5][6][7]

No diagnostic blood or molecular markers for endometriosis have been validated in clinical populations.[8]

References

  1. Wood C, Kuhn R, Tsaltas J (2002). "Laparoscopic diagnosis of endometriosis". Aust N Z J Obstet Gynaecol. 42 (3): 277–81. PMID 12230063.
  2. 2.0 2.1 2.2 2.3 Singh SS, Allaire C, Al-Nourhji O, et al. Guideline No. 449: diagnosis and impact of endometriosis—a canadian guideline. J Obstet Gynaecol Can. 2024;46(5):102450. doi:10.1016/j.jogc.2024.102450
  3. 3.0 3.1 Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Australian Clinical Practice Guideline for the Diagnosis and Management of Endometriosis. Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 2021. Accessed February 10, 2025. https://ranzcog.edu.au/wp-content/uploads/2022/02/Endometriosis-clinical-practice-guideline.pdf
  4. National Institute for Health and Care Excellence. Endometriosis: Diagnosis and Management: NICE Guideline 37. Published September 6, 2017. Updated April 16, 2024. Accessed January 13, 2025. https://www.nice.org.+uk/guidance/ng73/evidence/full-guideline-pdf-+4550371315
  5. Young SW, Jha P, Chamié L, et al. Society of Radiologists in Ultrasound consensus on routine pelvic US for endometriosis. Radiology. 2024;311(1): e232191. doi:10.1148/radiol.232191
  6. Leonardi M, Uzuner C, MestdaghW, et al. Diagnostic accuracy of transvaginal ultrasound for detection of endometriosis using International Deep Endometriosis Analysis (IDEA) approach: prospective international pilot study. Ultrasound Obstet Gynecol. 2022;60(3):404-413. doi:10.1002/ uog.24936
  7. Avery JC, Knox S, Deslandes A, et al; Imagendo Study Group. Noninvasive diagnostic imaging for endometriosis, 2: a systematic review of recent developments in magnetic resonance imaging, nuclear medicine and computed tomography. Fertil Steril. 2024;121(2):189-211. doi:10.1016/j.fertnstert. 2023.12.017
  8. Gibbons T, Rahmioglu N, Zondervan KT, Becker CM. Crimson clues: advancing endometriosis detection and management with novel blood biomarkers. Fertil Steril. 2024;121(2): 145-163. doi:10.1016/j.fertnstert.2023.12.018