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

Thomas Bainton, Jeyapala S, Sobanakumari Jeyapala, Zamora J, Javier Zamora, Khalid S. Khan, Raza A, Amer Raza
In: Authorea, Inc. · 2022 · doi:10.22541/au.166680200.01199407/v1 · W4307345602
Review preprint OA: gold CC0
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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 (2-hop)

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. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (52)

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