Research recommendations
The need for high-quality studies of predictive factors for endometriosis remains, particularly assessing populations attending primary care. Further multivariate analysis in powerful primary observational studies assessing factors that can be immediately and readily assessed in primary care would be of great value, as we anticipate the index tests assessed in this study to provide a greater degree of accuracy when applied in combination.4,37,51
We examined serum CA-125 at a cut off >35 U/mL, considered the upper limit of normal range, meta-analysis from 2016 found a cut off of 30 U/mL gave a sensitivity and specificity of 52% and 93% respectively, but sensitivity dropped to just 24% for detection of minimal disease.53 Further research assessing the accuracy of CA-125 at different thresholds and in combination with other tests could help improve accuracy.
Two recent studies (Fauconnier et al 2021 and Chapron et al 2022) assessed the accuracy of a patient-completed questionnaire and epidemiological data for the early identification of endometriosis and found it could do so with high diagnostic accuracy.24,55 Although these studies were conducted in a high-risk population undergoing surgery, the model maintained accuracy in population with a lower endometriosis prevalence of 10%. We do not anticipate a clinical score replacing laparoscopy due to it’s added therapeutic advantages and requirement to exclude other pathologies. If, however, disease can be predicted with a high degree of accuracy early on, medical therapy may be instigated, and referral made for definitive diagnosis and counselling regarding treatment, prognosis and fertility in a timely manner with the aim of reducing the current extraordinary delay.