Diagnosis of pelvic endometriosis: a systematic review and accuracy meta-analysis of non-invasive tests.

Thomas Bainton, Sobanakumari Jeyapala, Javier Zamora, Khalid S. Khan, Amer Raza
In: Authorea, Inc. · 2022 · doi:10.22541/au.166680200.01199407/v1 · W4307345602
review preprint OA: gold CC0
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This meta-analysis of 125 studies found that family history, dysmenorrhea, pelvic pain, dyschezia, dyspareunia, nulligravidity, TVUSS endometrioma, TVUSS invasive endometriosis, and CA-125 were associated with increased odds of pelvic endometriosis, while higher BMI was associated with decreased odds.

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Abstract

Background: Endometriosis is a chronic, often debilitating condition with a current significant delay from symptom onset to diagnosis. Objectives: To investigate the accuracy of symptoms, clinical history and non-invasive tests to predict pelvic endometriosis. Data sources: Medline, Embase, Web of Science and Scopus from conception to September 2022. Selection criteria: Primary test accuracy studies assessing selected non-invasive tests against a reference standard diagnosis for endometriosis. Data extraction and synthesis: Two authors independently conducted data extraction and study quality assessment. Grading of evidence was performed using a novel visual pentagon model. Meta-analyses of test accuracy was estimated using bivariate random effects models. Results: The 125 included studies (250,574 participants) showed mixed quality. Studies applying non-surgical (database/self-reporting) reference standard had a greater risk of bias. In 98 studies applying surgical reference standard, summary diagnostic odds ratios were: dysmenorrhoea 2.56 (95% confidence interval 1.99-3.29); pelvic pain 2.56 (1.73-3.74); dyschezia 2.05 (1.36-3.10); dyspareunia 2.45 (1.71-3.52); family history of endometriosis 6.79 (4.08-11.3); nulligravidity of 2.01 (1.62-2.50); BMI ≥30kg/m2 0.37 (0.19-0.68); TVUSS endometrioma 91.2 (44.0-189); TVUSS invasive endometriosis 26.1 (9.28-73.5); and CA-125 >35U/mL 16.0 (8.09-31.7). Sensitivity analysis excluding all high-risk studies found concordant results. Conclusions: This meta-analysis collated the performance of non-invasive tests for endometriosis across a comprehensive and geographically varied population. Study quality was mixed, however results were consistent with high-risk studies excluded. These findings will inform future prediction models for triage in primary care. Funding: This research received no specific funding. Keywords: Endometriosis; diagnosis; laparoscopy; pelvic pain; sub-fertility

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Condition tags

endometriosisendometriomadysmenorrheadyspareunia

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (52)

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