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.