Abstract
Objective: To summarise the current knowledge and trends in the diagnosis of endometriosis. Design: Review article.
Setting: Centre for diagnostics and treatment of endometriosis and Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital in Prague; Department of Gynaecology and Obstetrics, Burton Hospitals NHS, United Kingdom. Methods: Literature review.
Results: Diagnosis of endometriosis in the primary care is based on patient's history, physical examination and basic ultrasound, which can demonstrate endometriomas, adenomyosis and indirect signs of adhesions. Use of blood and urine biomarkers is not recommended.
Patients with suspected endometriosis should be referred to the specialized endometriosis centre where imaging experts in ultrasound and/or magnetic resonance, and experienced surgical team are available. High diagnostic accuracy of both imaging methods does not support routine use of laparoscopy in the diagnosis of the disease, but it may be considered eventually to exclude superficial and extrapelvic endometriosis in symptomatic patients with negative findings on imaging.
Conclusion: Community gynecologists should be able to perform basic ultrasound to diagnose endometriomas, adenomyosis and signs of pelvic adhesions, leading to an appropriate referral of the patient to a specialized endometriosis centre. Expert ultrasound diagnosis of advanced endometriosis including detection of pelvic deep endometriosis is usually reserved for specialised endometriosis centres.
Due to broad availability of ultrasound in gynecology, its lower cost and absence of known contraindications, ultrasound should be the diagnostic method of choice while magnetic resonance imaging should be used as a second stage test for difficult cases as a problem solving methods.