Endometriosis Imaging Diagnosis Beyond Specialized Centers: A Retrospective Cross-Sectional Study

Determine the accuracy of deep endometriosis (DE) and ovarian endometrioma (OE) diagnosis on pelvic MRI in non-specialized tertiary healthcare, taking surgical diagnosis as the reference test. Additionally, we aimed to evaluate symptom severity and the presence and size of endometriomas as predictors of DE detection during surgery.

This retrospective cross-sectional study assessed endometriosis patients presenting to a tertiary healthcare center over one year (2018-2019). Pelvic MRI data, obtained within six months of surgery, were extracted from radiologic reports. A symptom severity score (SSS) was used to estimate symptom severity.

Pelvic MRI exhibited low sensitivity (75.6%) and high specificity (100%) for DE (n=96). Conversely, OE was diagnosed with high sensitivity (100%) and specificity (93.9%; n=122). Three-way contingency analysis showed that, irrespective of the presence and size of endometrioma, there was a correlation between symptom severity and detection of DE during surgery (OR=6.6, p-value≤0.001; n=287). In a multivariable logistic regression analysis model controlling for endometrioma size, a higher SSS was significantly associated with a higher risk of DE detection during surgery (SSS=1: OR=4.65, p≤0.001; SSS=2: OR=10.66, p≤0.001; n=287). However, when controlling for symptom severity, there was no significant association between the presence and size of endometrioma and surgical detection of DE (endometrioma ≥5 cm: OR=1.57, p>0.05; n=287).

While pelvic MRI effectively identifies DE in this population, caution is advised regarding negative DE MRI results in non-specialized settings. Based on our findings, a high suspicion for DE should be maintained in patients with severe symptoms.