Diagnostic Test Accuracy Protocol

Non-invasive tests for the diagnosis of endometriosis

  1. Vicki Nisenblat1,
  2. Cindy Farquhar2,
  3. Ali Akoum3,
  4. Ian Fraser4,
  5. Patrick MM Bossuyt5,
  6. M Louise Hull1,*

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 18 JAN 2012

Assessed as up-to-date: 5 DEC 2011

DOI: 10.1002/14651858.CD009591


How to Cite

Nisenblat V, Farquhar C, Akoum A, Fraser I, Bossuyt PMM, Hull ML. Non-invasive tests for the diagnosis of endometriosis (Protocol). Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD009591. DOI: 10.1002/14651858.CD009591.

Author Information

  1. 1

    University of Adelaide, Department of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, Adelaide, South Austraila, Australia

  2. 2

    University of Auckland, Obstetrics and Gynaecology, Auckland, New Zealand

  3. 3

    Laval University, Obstetrics and Gynaecology, Quebec, Canada

  4. 4

    The University of Sydney, Professor in Reproductive Medicine, Sydney, NSW, Australia

  5. 5

    Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology and Biostatistics, Amsterdam, Netherlands

*M Louise Hull, Department of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, University of Adelaide, King William Road, Adelaide, South Austraila, Australia. louise.hull@adelaide.edu.au.

Publication History

  1. Publication Status: New
  2. Published Online: 18 JAN 2012

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Abstract

  1. Top of page
  2. Abstract

This is the protocol for a review and there is no abstract. The objectives are as follows:

The aim of this review is to provide summary estimates of the diagnostic accuracy of non-invasive tests for the diagnosis of endometriomas and pelvic endometriosis.

We will review studies evaluating the accuracy of all non-invasive tests that have been proposed for the diagnosis of endometriosis, including diagnostic imaging techniques (USS and MRI), blood markers and eutopic endometrial markers, compared to surgical diagnosis as a reference standard. We will evaluate each of the tests singly or in combination with other tests (when they have been used in a diagnostic algorithm).

We aim to determine whether there is a non-invasive test that distinguishes women with and without endometriomas or pelvic endometriosis, or both, that is accurate enough to provide a clinical utility. This will include the diagnostic value either as a replacement or triage test.

If there are sufficient data, we will:

1. assess the sensitivity and specificity of each diagnostic test in subgroups of women with different presenting symptoms of endometriosis (subfertility, pelvic pain, ovarian mass, asymptomatic women);

2. assess the sensitivity and specificity of each diagnostic test in women with different rASRM stages of endometriosis ( Table 1).

We anticipate the following potential sources of heterogeneity.

  • Clinical factors:
    • characteristics of study population (age, clinical presentation, stage of disease);
    • variability in test methodology related to changes in technology (e.g. the improved quality of imaging and assays over time may alter the sensitivity and specificity of the test);
    • use of histological confirmation in conjunction with laparoscopic visualisation to diagnose endometriosis.
  • Methodological factors:
    • study design (patient selection, case-control or cohort design, concealment of allocation and blinding in randomised controlled trials).

  • characteristics of study population (age, clinical presentation, stage of disease);
  • variability in test methodology related to changes in technology (e.g. the improved quality of imaging and assays over time may alter the sensitivity and specificity of the test);
  • use of histological confirmation in conjunction with laparoscopic visualisation to diagnose endometriosis.

  • study design (patient selection, case-control or cohort design, concealment of allocation and blinding in randomised controlled trials).

Although we will attempt to assess these sources of heterogeneity, there may not be a sufficient number of studies evaluating each test to make this a meaningful analysis. Furthermore, observer variability bias or bias related to interpretation of results cannot be formally assessed in the context of this review.

Some of the sources of heterogeneity are more applicable to certain categories of index tests and therefore will not be universally investigated for every test.