Objective: To develop a clinical index that will positively predict the presence of endometriosis.
Design: Prospective single-center observational study. Setting: A hospital-based institute.
Patients: 120 patients affected by chronic pelvic pain, infertility or with clinical suspicion of endometriosis. Interventions: Electronic processing of clinical data with software-assistance at the end of each consultation and digital video recording of surgeries.
Main Outcome Measures: Endometriosis Index (EI), the score calculated using clinical parameters correlated with macroscopic/microscopic presence or absence of endometriosis.
Results: Endometriosis was staged and treated in 95 cases, the remaining 25 women presented benign pathology with no endometriosis. Patients with positive operative findings of endometriosis had a mean (± standard deviation) pre-operative EI score of 22 ± 12, while mean EI value of patients with no operative findings of endometriosis was 8 ± 6 (p<0.001). Cumulative distribution of EI shows increasing values from controls to peritoneal, ovarian and deeply infiltrating endometriosis (DIE) (p for trend <0.001). A logistic model showed an OR = 24.7 (95%CI=8.3 to 73.7) of having DIE for women with EI score > 28 (75th percentile value) versus women with EI score ≤ 28; with EI score > 28 this non-invasive test was predictive of DIE with a sensitivity of 72.4% and a specificity of 90.1%.
Conclusions: These data suggest that a dedicated Endometriosis Index is effective in identifying patients who would benefit from early surgical management. We propose the use of this non-invasive tool to reduce the delay between the onset of symptoms and a surgical diagnosis of endometriosis.