Main findings
This meta-analysis presents an up-to-date, large, and geographically varied data set identifying predictive factors for diagnosis of pelvic endometriosis with a high degree of confidence. Index tests showed a positive association with endometriosis and trended towards a greater specificity than sensitivity, excluding elevated BMI, which demonstrated an inverse correlation. TVUSS finding of endometrioma reached a desired threshold for use as a ‘rule-in’ test and none achieved a summary sensitivity of >95% for ‘rule-out’. A family history of endometriosis, dyschezia and serum CA-125 >35U/mL showed summary specificity of >90% although low sensitivity. Sensitivity was poor for symptom and clinical history tests, where the best performing was dysmenorrhoea.