Diagnosis of endometriosis in the 21st century

Endometriosis is a common disease but, due to the wide spectrum of symptoms, diagnosis can be delayed 8-12 years. Laparoscopy is nowadays the gold standard for diagnosis. A less invasive method could shorten the time to diagnosis. The aim of this review is to systematically summarize the literature regarding possible less invasive methods for the diagnosis of endometriosis. Electronic databases, including MEDLINE/PubMed, Cochrane, and Google Scholar, were searched to identify relevant studies; 53 publications contributed to this review. Low invasive tests including imaging, genetic tests, biomarkers, or miRNAs could be the key for establishing a less invasive diagnosis of endometriosis. The findings generally support that different methods can differently contribute to the diagnosis, also depending on the type of endometriosis. For example, transvaginal ultrasound has a sensitivity of 93% and a specificity of 96% in the diagnosis of endometrioma, while superficial/peritoneal endometriosis cannot be detected with imaging processes. Although several non-invasive tests including imaging, genetic tests, biomarkers, or miRNAs show promising diagnostic potential, further research is required before they can be recommended in routine clinical care. The combination of low invasive tests may be the solution to a reliable low invasive diagnosis of endometriosis.