Diagnosis of pelvic endometriosis: a systematic review and accuracy
meta-analysis of non-invasive tests.
Background: Endometriosis is a chronic, often debilitating condition
with a current significant delay from symptom onset to diagnosis.
Objectives: To investigate the accuracy of symptoms, clinical history
and non-invasive tests to predict pelvic endometriosis. Data sources:
Medline, Embase, Web of Science and Scopus from conception to September
2022. Selection criteria: Primary test accuracy studies assessing
selected non-invasive tests against a reference standard diagnosis for
endometriosis. Data extraction and synthesis: Two authors independently
conducted data extraction and study quality assessment. Grading of
evidence was performed using a novel visual pentagon model.
Meta-analyses of test accuracy was estimated using bivariate random
effects models. Results: The 125 included studies (250,574 participants)
showed mixed quality. Studies applying non-surgical
(database/self-reporting) reference standard had a greater risk of bias.
In 98 studies applying surgical reference standard, summary diagnostic
odds ratios were: dysmenorrhoea 2.56 (95% confidence interval
1.99-3.29); pelvic pain 2.56 (1.73-3.74); dyschezia 2.05 (1.36-3.10);
dyspareunia 2.45 (1.71-3.52); family history of endometriosis 6.79
(4.08-11.3); nulligravidity of 2.01 (1.62-2.50); BMI ≥30kg/m2 0.37
(0.19-0.68); TVUSS endometrioma 91.2 (44.0-189); TVUSS invasive
endometriosis 26.1 (9.28-73.5); and CA-125 >35U/mL 16.0
(8.09-31.7). Sensitivity analysis excluding all high-risk studies found
concordant results. Conclusions: This meta-analysis collated the
performance of non-invasive tests for endometriosis across a
comprehensive and geographically varied population. Study quality was
mixed, however results were consistent with high-risk studies excluded.
These findings will inform future prediction models for triage in
primary care. Funding: This research received no specific funding.
Keywords: Endometriosis; diagnosis; laparoscopy; pelvic pain;