Page 16 - Diagnostic delay of endometriosis

of endometriosis has been found to be superior to clinical examination, especially for ovarian and rectosigmoid involvement. Positive and negative predictive value for detecting deep endometriosis has been estimated at 87-100% and 90-98% respectively, again if performed by experienced operators.34 When deep endometriosis is suspected, magnetic resonance imaging may be helpful to map the extent of the disease prior to surgery, in order to gain information on multifocality of the lesions and infiltration depth of for example the bowel wall.36 Although these imaging techniques have been proven to be useful in the detection of endometriosis, they lack the possibility to identify superficial peritoneal lesions and to collect tissue for histological evaluation, and are therefore not capable of establishing a definite diagnosis. An expanding number of biomarkers retrieved from endometrial tissue, menstrual fluid, serum, plasma or urine have been studied for their use as a non-invasive diagnostic test for endometriosis. Unfortunately, none of them has been clearly proven to be of clinical use.37-41
Laparoscopy
In women with symptoms and signs suggestive of endometriosis it should be considered to start empirical first line medical treatment, such as analgesics and basic hormonal treatment (continuous combined oral contraceptives or progestagens) before resorting to an invasive procedure like laparoscopy to obtain histological proof of the disease.4, 42 Arguments to perform a laparoscopy include the woman’s wish to have a definitive diagnosis, subfertility, symptoms and signs indicating advanced disease (ovarian endometrioma and deep infiltrating lesions) and/or unresponsiveness to prior medical treatment. Although laparoscopy allows the clinician to confirm or rule out the presence of endometriosis with a high level of accuracy, a clinical diagnosis based on patient history, pelvic examination and imaging techniques is increasingly advocated due to the safety profile and increasing accuracy.42 A thorough preoperative work-up can allow for a limited number of laparoscopies, shifting from a merely diagnostic to a comprehensive “see- and-treat” strategy.
Diagnostic delay
Due to the wide variety in symptomatology and the lack of an accurate non-invasive diagnostic test, it has been proven difficult for many clinicians to establish a timely diagnosis of endometriosis. Diagnostic delay in endometriosis is defined as the interval between first onset of symptoms and
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