Early identification of women with endometriosis by means of a simple patient-completed questionnaire screening tool: a diagnostic study

Arnaud Fauconnier, Hocine Drioueche, Cyrille Huchon, Joseph Du Cheyron, Émilie Indersie, Emilie Indersie, Yasmine Candau, Pierre Panel, P. Panel, Xavier Fritel
Fertility and sterility · 2021 · vol. 116(6) , pp. 1580–1589 · doi:10.1016/j.fertnstert.2021.07.1205 · PMID:34538656 · W3199618029
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A 21-item patient questionnaire assessing painful symptoms achieved high diagnostic accuracy for identifying women with or without endometriosis.

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Abstract

ObjectivesTo assess the value of a self-completed questionnaire based on patients’ verbal descriptors of pelvic painful symptoms to identify women with endometriosis.DesignProspective 1:2 nonmatched case-control study.SettingThree French endometriosis referral centers.Patient(s)Endometriosis cases were women aged 18–45 years with endometriosis confirmed by histology. Controls were as follows: asymptomatic women attending a gynecologic consultation for routine examination; women without evidence of endometriosis consulting for pain/infertility; and population-based controls from the same urban locations.Intervention(s)All women completed the 21-item yes/no questionnaire about painful symptoms.Main Outcome Measure(s)The area under the receiver operating characteristic curve of the full question set model based on binary logistic regression and the diagnostic accuracy of low- and high-risk classification rules based on selected threshold of the prediction model.Result(s)We included 105 cases and 197 controls (45 asymptomatic consultation-based controls, 66 women without endometriosis consulting for pain/infertility, and 86 population-based controls). The full question set prediction model, including age, had an area under the receiver operating characteristic curve of 0.92 (95% confidence interval, 0.87–0.95) after internal validation. The high-risk classification rule had a specificity of 98.0% and a positive likelihood ratio of 30.5. The low-risk classification rule had a sensitivity of 98.1% and a negative likelihood ratio of 0.03. For a hypothesized pretest prevalence of 10%, the high- and low-risk prediction rules ascertained endometriosis with posttest probability rates of 77.2% and 0.3%, respectively.Conclusion(s)A self-completed patient-centered questionnaire can identify women at low or high risk of endometriosis with a high diagnostic accuracy and, thus, may help early identification of women with endometriosis. To assess the value of a self-completed questionnaire based on patients’ verbal descriptors of pelvic painful symptoms to identify women with endometriosis. Prospective 1:2 nonmatched case-control study. Three French endometriosis referral centers. Endometriosis cases were women aged 18–45 years with endometriosis confirmed by histology. Controls were as follows: asymptomatic women attending a gynecologic consultation for routine examination; women without evidence of endometriosis consulting for pain/infertility; and population-based controls from the same urban locations. All women completed the 21-item yes/no questionnaire about painful symptoms. The area under the receiver operating characteristic curve of the full question set model based on binary logistic regression and the diagnostic accuracy of low- and high-risk classification rules based on selected threshold of the prediction model. We included 105 cases and 197 controls (45 asymptomatic consultation-based controls, 66 women without endometriosis consulting for pain/infertility, and 86 population-based controls). The full question set prediction model, including age, had an area under the receiver operating characteristic curve of 0.92 (95% confidence interval, 0.87–0.95) after internal validation. The high-risk classification rule had a specificity of 98.0% and a positive likelihood ratio of 30.5. The low-risk classification rule had a sensitivity of 98.1% and a negative likelihood ratio of 0.03. For a hypothesized pretest prevalence of 10%, the high- and low-risk prediction rules ascertained endometriosis with posttest probability rates of 77.2% and 0.3%, respectively. A self-completed patient-centered questionnaire can identify women at low or high risk of endometriosis with a high diagnostic accuracy and, thus, may help early identification of women with endometriosis.

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Condition tags

mesh:D004715endometriosisinfertility

MeSH descriptors

Endometriosis Patient-Centered Care Surveys and Questionnaires Adolescent Adult Case-Control Studies Early Diagnosis Endometriosis Endometriosis Female Humans Middle Aged Patient-Centered Care Prospective Studies Risk Factors Young Adult

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