An evidence‐based approach to assessing surgical versus clinical diagnosis of symptomatic endometriosis

Abstract

Challenges intrinsic to the accurate diagnosis of endometriosis contribute to an extended delay between the onset of symptoms and clinical confirmation. Intraoperative visualization, preferably with histologic verification, is considered by many professional organizations to be the gold standard by which endometriosis is diagnosed. Clinical diagnosis of symptomatic endometriosis via patient history, physical examination, and noninvasive tests, though more easily executed, is generally viewed as less accurate than surgical diagnosis. Technological advances and increased understanding of the pathophysiology of endometriosis warrant continuing reevaluation of the standard method for diagnosing symptomatic disease. A review of the published literature was therefore performed with the goal of comparing the accuracy of clinical diagnostic measures with that of surgical diagnosis. The current body of evidence suggests that clinical diagnosis of symptomatic endometriosis is more reliable than previously recognized and that surgical diagnosis has limitations that could be underappreciated. Regardless of the methodology used, women with suspected symptomatic endometriosis would be well served by a diagnostic paradigm that is reliable, conveys minimal risk of under- or over-diagnosis, lessens the time from symptom development to diagnosis, and guides the appropriate use of medical and surgical management strategies.

Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment

“…Whom should we believe? “Clinicians and patients should know whether and to what extent medical treatments are effective for DIE, under what circumstances can they be used, and if they really constitute an acceptable alternative to surgical treatments” 83 . The authors state that “different hormones, or hormonal combinations relieve pain and other symptoms of DIE.…”

“…The authors state that “different hormones, or hormonal combinations relieve pain and other symptoms of DIE. Improvement in dyspareunia, dyschezia, and bowel complaints suggests that they are efficacious” 83 .…”

A Clinician's Guide to the Treatment of Endometriosis with Elagolix

“…It is increasingly recognized that identification of endometriosis can be achieved with reasonable certainty using nonsurgical methodologies (i.e., a clinical diagnosis), which include evaluation of pelvic pain symptoms, patient history, physical examination findings, and appropriately performed imaging studies. [38][39][40][41] Although there has yet to be identified a replacement test or tests for diagnostic surgery, 42,43 clinicians with expertise in endometriosis diagnosis and management have suggested that symptoms, patient history, and clinical assessments taken in totality provide a basis for clinical diagnosis. 39,40 The benefits of undertaking a clinical diagnosis approach are that it does not require surgery and the attendant risks thereof, utilizes assessment tools that are readily available to most clinicians, and may reduce the delay frequently observed in endometriosis diagnosis.…”

“…[38][39][40][41] Although there has yet to be identified a replacement test or tests for diagnostic surgery, 42,43 clinicians with expertise in endometriosis diagnosis and management have suggested that symptoms, patient history, and clinical assessments taken in totality provide a basis for clinical diagnosis. 39,40 The benefits of undertaking a clinical diagnosis approach are that it does not require surgery and the attendant risks thereof, utilizes assessment tools that are readily available to most clinicians, and may reduce the delay frequently observed in endometriosis diagnosis. In clinical practice, presumptive diagnosis of endometriosis is often made without laparoscopy or other surgical procedure 2,44 and can facilitate early and effective management of patients' symptoms.…”

The Diagnostic Accuracy of Combined Enolase/Cr, CA125, and CA19-9 in the Detection of Endometriosis

“…The gold standard for the diagnosis of endometriosis is direct visualization of a lesion in laparoscopy and histological confirmation of suspicious lesions in biopsy specimens [ 6 ]. The invasive nature of laparoscopy and the ambiguous symptoms tend to delay the diagnosis [ 7 ]. Due to the progressive nature of endometriosis, any delay in its diagnosis or treatment is liable to have severe consequences for the patient [ 8 ], including impairment of the patient's quality of life [ 9 ].…”