From the Guidelines
Diagnosing endometriosis typically requires a combination of clinical evaluation, imaging studies, and laparoscopic surgery with tissue biopsy, which remains the gold standard for definitive diagnosis. The diagnostic criteria for endometriosis involve a comprehensive assessment of symptoms, physical examination, and imaging studies. According to the most recent study [ 1 ], the diagnosis of endometriosis is challenging due to variable presenting symptoms and nonspecific physical examination findings.
Clinical Evaluation
Before surgery, doctors will evaluate symptoms including:
- Pelvic pain
- Painful periods
- Pain during intercourse
- Infertility A thorough pelvic exam may reveal tender nodules or pain.
Imaging Studies
Imaging studies such as:
- Transvaginal ultrasound can identify endometriomas (chocolate cysts) and deep infiltrating endometriosis
- MRI provides additional detail for complex cases
- Expanded protocol transvaginal ultrasound (TVUS) studies have been developed to identify and “map” deep endometriosis
Laparoscopic Surgery
Laparoscopic surgery with tissue biopsy remains the gold standard for definitive diagnosis. During laparoscopy, visible endometrial implants are removed and biopsied, providing both diagnosis and treatment.
Blood Tests
Blood tests for CA-125 may be elevated but aren't specific enough for diagnosis alone. Many doctors initiate empiric treatment with hormonal medications like combined oral contraceptives, progestins, or GnRH agonists when endometriosis is strongly suspected, even without surgical confirmation. This approach is reasonable for patients with typical symptoms who respond to hormonal therapy. However, surgical diagnosis becomes important when symptoms are severe, don't respond to medical therapy, or when fertility is a concern. The diagnostic delay for endometriosis averages 7-10 years, highlighting the importance of considering this condition in women with chronic pelvic pain or unexplained infertility [ 1 ].
From the Research
Diagnostic Criteria for Endometriosis
The diagnostic criteria for endometriosis involve a combination of clinical evaluation, laboratory tests, imaging techniques, and surgical staging with histological examination. The key diagnostic criteria include:
- Visualization of endometriotic lesions through laparoscopy 2, 3
- Histologic confirmation of endometrial glands and stroma outside of the uterine cavity 2, 3
- Clinical presentations such as dysmenorrhea, pelvic pain, dyspareunia, infertility, and pelvic mass 4
- Laboratory markers, such as serum CA-125, although limited in value 4
- Imaging techniques, including transvaginal ultrasound and magnetic resonance imaging, to detect endometriotic cysts and deep infiltrating lesions 4, 5
Diagnostic Tools and Techniques
Various diagnostic tools and techniques are used to diagnose endometriosis, including:
- Laparoscopy, which is considered the gold standard for diagnosing endometriosis 2, 3, 6
- Transvaginal ultrasound and magnetic resonance imaging to evaluate the extent of the disease 4, 5
- Histopathological examination of excised lesions to confirm the diagnosis 2, 3
- Video-assisted laparoscopy (VALS) for the detection and diagnosis of endometriosis 6
Accuracy and Reliability of Diagnostic Tools
The accuracy and reliability of diagnostic tools for endometriosis vary, with:
- Laparoscopy alone presenting 97.68% sensitivity, 79.23% specificity, 72% positive predictive value, and 98.42% negative predictive value 3
- Imaging techniques, such as transvaginal ultrasound and magnetic resonance imaging, improving the accuracy of clinical diagnosis and facilitating preoperative mapping of endometriotic lesions 5