Revue systématique de la littérature de la sensibilité et de la spécificité des symptômes de l’endométriose en soins primaires

Introduction: endometriosis is a complex chronic disease affecting around 10% of women of childbearing age, with diagnosis often delayed. Recent recommendations suggest a non-invasive, symptom-based diagnostic approach in primary care. Few data exist on their diagnostic performance in primary care. The main objective was to evaluate the sensitivity and specificity of endometriosis symptoms in primary care. Methods: we conducted a systematic literature review searching Pubmed, Scopus and Cinhal databases until February 8, 2024. Included studies were required to provide data on the sensitivity, specificity and/or predictive values of endometriosis symptoms in women of childbearing age from a primary care population, compared with the reference test (surgery or MRI). Results: the search yielded 831 results, and we included 5 studies, 4 of which came from the literature review. The strategies evaluated were of 3 types: risk scores, questionnaires and symptom analysis. Diagnostic performance was difficult to establish precisely in the absence of accurate prevalence data. The best diagnostic performances were found for dysmenorrhoea, with sensitivity ranging from 65% to 88.89% and specificity from 27% to 70%. Dyspareunia had a sensitivity of 32.43% to 67.5% and a specificity of 62% to 70%. Infertility had a sensitivity ranging from 14 to 75% and a specificity from 68.18 to 74%. Pelvic pain had a sensitivity of 32 to 58% and a high specificity of 61 to 91%. Discussion: although there are no symptoms specific to endometriosis, certain recurrent symptoms, associated with a family history, should alert patients to the diagnosis. These findings support recommendations to use symptoms to establish a level of diagnostic suspicion for appropriate patient referral.