{"paper_id":"7c68ba84-6acc-44c7-a3b1-98765e27232e","body_text":"Response: Clues to revising the conventional diagnostic algorithm for endometriosis\nCorresponding Author\nAndrew Spiers\nDepartment of Obstetrics and Reproductive Medicine, Angers University Hospital, Angers, France\nEndometriosis Expert Center – Pays de la Loire, Angers, France\nCorrespondence\nAndrew Spiers, Department of Gynecology-Obstetrics, Angers University, Hospital, 4 Rue Larrey, 49100 Angers, France.\nEmail: [email protected]\nSearch for more papers by this authorHorace Roman\nFranco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France\nSearch for more papers by this authorMegan Wasson\nDepartment of Gynecologic Surgery, Mayo Clinic, Phoenix, Arizona, USA\nSearch for more papers by this authorCharles Chapron\nDepartment of Gynecology Obstetrics and Reproductive Medicine, Cochin University Hospital, Paris, France\nDepartment ‘Development, Reproduction and Cancer’, Institut Cochin, INSERM U1016, Descartes University, Paris, France\nSearch for more papers by this authorPascal Rousset\nDepartment of Diagnostic and Interventional Imaging, Lyon Sud University Hospital, Lyon, France\nSearch for more papers by this authorFrançois Golfier\nDepartment of Obstetrics and Reproductive Medicine, Lyon South University Hospital, Lyon, France\nEndometriosis Expert Center—Steering Committee of the EndAURA Network, Lyon, France\nSearch for more papers by this authorRaffaele Fauvet\nDepartment of Obstetrics and Reproductive Medicine, Cote De Nacre University Hospital, Caen, France\nSearch for more papers by this authorLéa Delbos\nDepartment of Obstetrics and Reproductive Medicine, Angers University Hospital, Angers, France\nEndometriosis Expert Center – Pays de la Loire, Angers, France\nSearch for more papers by this authorHervé Fernandez\nDepartment of Obstetrics and Reproductive Medicine, Paris Sud University Hospital, Kremlin Bicetre APHP, Paris, France\nSearch for more papers by this authorPhilippe Descamps\nDepartment of Obstetrics and Reproductive Medicine, Angers University Hospital, Angers, France\nEndometriosis Expert Center – Pays de la Loire, Angers, France\nSearch for more papers by this authorSofiane Bendifallah\nDepartment of Surgery, American Hospital of Paris, Neuilly sur seine, France\nSearch for more papers by this authorCorresponding Author\nAndrew Spiers\nDepartment of Obstetrics and Reproductive Medicine, Angers University Hospital, Angers, France\nEndometriosis Expert Center – Pays de la Loire, Angers, France\nCorrespondence\nAndrew Spiers, Department of Gynecology-Obstetrics, Angers University, Hospital, 4 Rue Larrey, 49100 Angers, France.\nEmail: [email protected]\nSearch for more papers by this authorHorace Roman\nFranco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France\nSearch for more papers by this authorMegan Wasson\nDepartment of Gynecologic Surgery, Mayo Clinic, Phoenix, Arizona, USA\nSearch for more papers by this authorCharles Chapron\nDepartment of Gynecology Obstetrics and Reproductive Medicine, Cochin University Hospital, Paris, France\nDepartment ‘Development, Reproduction and Cancer’, Institut Cochin, INSERM U1016, Descartes University, Paris, France\nSearch for more papers by this authorPascal Rousset\nDepartment of Diagnostic and Interventional Imaging, Lyon Sud University Hospital, Lyon, France\nSearch for more papers by this authorFrançois Golfier\nDepartment of Obstetrics and Reproductive Medicine, Lyon South University Hospital, Lyon, France\nEndometriosis Expert Center—Steering Committee of the EndAURA Network, Lyon, France\nSearch for more papers by this authorRaffaele Fauvet\nDepartment of Obstetrics and Reproductive Medicine, Cote De Nacre University Hospital, Caen, France\nSearch for more papers by this authorLéa Delbos\nDepartment of Obstetrics and Reproductive Medicine, Angers University Hospital, Angers, France\nEndometriosis Expert Center – Pays de la Loire, Angers, France\nSearch for more papers by this authorHervé Fernandez\nDepartment of Obstetrics and Reproductive Medicine, Paris Sud University Hospital, Kremlin Bicetre APHP, Paris, France\nSearch for more papers by this authorPhilippe Descamps\nDepartment of Obstetrics and Reproductive Medicine, Angers University Hospital, Angers, France\nEndometriosis Expert Center – Pays de la Loire, Angers, France\nSearch for more papers by this authorSofiane Bendifallah\nDepartment of Surgery, American Hospital of Paris, Neuilly sur seine, France\nSearch for more papers by this authorDATA AVAILABILITY STATEMENT\nData sharing is not applicable to this article as no new data were created or analyzed in this study.\nREFERENCES\n- 1Spiers A, Roman H, Wasson M, et al. Clues to revising the conventional diagnostic algorithm for endometriosis. Int J Gynaecol Obstet. 2025; 168(1): 101-111. doi:10.1002/ijgo.15840\n- 2Bendifallah S, Puchar A, Suisse S, et al. Machine learning algorithms as new screening approach for patients with endometriosis. Sci Rep. 2022; 12: 639. doi:10.1038/s41598-021-04637-2\n- 3Chapron C, Lafay-Pillet M-C, Santulli P, et al. A new validated screening method for endometriosis diagnosis based on patient questionnaires. EClinicalMedicine. 2022; 44:101263. doi:10.1016/j.eclinm.2021.101263\n- 4Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Human Reproduction Open. 2022; 2:hoac009. doi:10.1093/hropen/hoac009\n10.1093/hropen/hoac009Google Scholar\n- 5Howard FM. An evidence-based medicine approach to the treatment of endometriosis-associated chronic pelvic pain: placebo-controlled studies. J Am Assoc Gynecol Laparosc. 2000; 7(4): 477-488. doi:10.1016/s1074-3804(05)60360-x\n- 6Guo S-W. Recurrence of endometriosis and its control. Hum Reprod Update. 2009; 15(4): 441-461. doi:10.1093/humupd/dmp007\n- 7Brown J, Crawford TJ, Allen C, Hopewell S, Prentice A, Cochrane Gynaecology and Fertility Group. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2017; 1(1):CD004753. doi:10.1002/14651858.CD004753.pub4\n- 8Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019; 15(11): 666-682. doi:10.1038/s41574-019-0245-z\n- 9Bendifallah S, Dabi Y, Suisse S, et al. Validation of a salivary miRNA signature of endometriosis – interim data. NEJM Evidence. 2023; 2,7:EVIDoa2200282. doi:10.1056/EVIDoa2200282\n10.1056/EVIDoa2200282Google Scholar\n- 10Ferrier C, Bendifallah S, Suisse S, et al. Saliva microRNA signature to diagnose endometriosis: a cost-effectiveness evaluation of the Endotest®. BJOG. 2023; 130(4): 396-406. doi:10.1111/1471-0528.17348\n- 11Bendifallah S, Roman H, Suisse S, et al. Validation of a saliva micro-RNA signature for endometriosis. NEJM Evidence. 2025; 4:EVIDoa2400195. doi:10.1056/EVIDoa2400195\n- 12 ClinicalTrials.gov [Internet]. Interest of Salivary Signature of Endometriosis in the Healthcare Pathway of Adolescent: The ADOmiARN Study. Bethesda, MD: National Library of Medicine (US). Identifier NCT05928442, July 3, 2023. Accessed April 26, 2026. https://clinicaltrials.gov/study/NCT05928442\n- 13 ClinicalTrials.gov [Internet]. Impact of Ziwig Endotest® on the Management of Patients With Clinical Symptoms of Endometriosis Inconsistent With Their Imaging Work-up: ENDOBEST. Bethesda, MD: National Library of Medicine (US). Identifier NCT06794424. 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