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Validation study of nonsurgical diagnosis of endometriosis
B Eskenazi1, M Warner, L Bonsignore
1School of Public Health, University of California, CA, Berkeley 94720-7360, USA. eskenazi@uclink4.berkeley.edu
Objective:
To determine whether the surgical diagnosis of endometriosis can be predicted using symptoms, signs, and ultrasound findings.
Design:
Prospective study (study sample); retrospective record review (test sample).
Setting:
Hospital of Desio (study sample) and Mangiagalli Hospital (test sample), Italy.
Patient(S):
Ninety women scheduled to undergo laparoscopy or laparotomy (study sample); 120 women who underwent laparoscopy (test sample).
Intervention:
The study sample group was interviewed before surgery about infertility and dysmenorrhea, dyspareunia, and noncyclic pelvic pain and each member had a pelvic examination and a transvaginal ultrasound. At surgery, endometriosis was noted. For the test sample, the same information was abstracted from medical records after laparoscopy.
Main Outcome Measure(S):
The ability of symptoms, signs, and ultrasound to predict endometriosis at surgery. A classification tree was developed with the study sample and evaluated with the test sample.
Result(S):
Ovarian endometriosis, but not nonovarian endometriosis, could be reliably predicted with noninvasive tools. Ultrasound and examination best predicted ovarian endometriosis, correctly classifying 100% of cases with no false positive diagnoses in the study sample. Similar results were found in the test sample.
Conclusion(S):
Noninvasive tools may be used to identify women with ovarian, but not nonovarian endometriosis, with excellent agreement with surgical diagnosis.