Endometriosis (Suspected)
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Population Covered By The Guidance
This pathway provides guidance on the investigation of adult patients with suspected endometriosis.
Date reviewed: August 2014
Date of next review: June 2023
Published: December 2014
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
 |
None | 0 |
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Minimal | < 1 millisieverts |
 |
Low | 1-5 mSv |
 |
Medium | 5-10 mSv |
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High | >10 mSv |
Teaching Points
Teaching Points
- Transvaginal Ultrasonography should be the initial choice of imaging investigation in the assessment of endometriosis
- Where inconclusive specialist gynaecological opinion should be sought early where the decision for use of more specialised imaging modalities like MRI and specialised ultrasonography can be made
- Rarely diagnostic laparoscopy can be used to aid in assisting the diagnosis of endometriosis
References
References
Date of literature search: April 2014
The search methodology is available on request. Email
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698-704. (Evidence based guideline). View the reference
- Piketty M, Chopin N, Dousset B, Millischer-Bellaische AE, Roseau G, Leconte M, et al. Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum Reprod. 2009;24(3):602-7. (Level I evidence). View the reference
- Rock JA, Markham SM. Pathogenesis of endometriosis. Lancet. 1992;340(8830):1264-7. (Review article). View the reference
- Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789-99. (Review article). View the reference
- Pearce CL, Templeman C, Rossing MA, Lee A, Near AM, Webb PM, et al. Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies. Lancet Oncol. 2012;13(4):385-94. (Level III evidence). View the reference
- Heidemann LN, Hartwell D, Heidemann CH, Jochumsen KM. The relation between endometriosis and ovarian cancer - a review. Acta Obstet Gynecol Scand. 2014;93(1):20-31. (Level II/III evidence). View the reference
- Van Gorp T, Amant F, Neven P, Vergote I, Moerman P. Endometriosis and the development of malignant tumours of the pelvis. A review of literature. Best Pract Res Clin Obstet Gynaecol. 2004;18(2):349-71. (Review article). View the reference
- Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012;39(4):535-49. (Review article). View the reference
- Bianek-Bodzak A, Szurowska E, Sawicki S, Liro M. The importance and perspective of magnetic resonance imaging in the evaluation of endometriosis. Biomed Res Int. 2013;2013:436589. (Review article). View the reference
- Bazot M, Malzy P, Cortez A, Roseau G, Amouyal P, Darai E. Accuracy of transvaginal sonography and rectal endoscopic sonography in the diagnosis of deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2007;30(7):994-1001. (Level II evidence). View the reference
- Hudelist G, English J, Thomas A, Tinelli A, Singer C, Keckstein J. Diagnostic accuracy of transvaginal ultrasound for non invasive diagnosis of bowel endometriosis: systematic review and meta analysis. Ultrasound Obstet Gynacol. 2011;37(3):257-63. (Level I evidence). View the reference
- Brown J, Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2014;3:CD009590. (Level I evidence).
- Roy C, Balzan C, Thoma V, Sauer B, Wattiez A, Leroy J. Efficiency of MR imaging to orientate surgical treatment of posterior deep pelvic endometriosis. Abdom Imaging. 2009;34(2):251-9. (Level II evidence). View the reference
- Azot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology. 2004;232(2):379-89. (Level I evidence). View the reference
- Hottat N, Larrousse C, Anaf V, Noel JC, Matos C, Absil J, et al. Endometriosis: contribution of 3.0-T pelvic MR imaging in preoperative assessment--initial results. Radiology. 2009;253(1):126-34. (Level II evidence). View the reference
- Bazot M, Bornier C, Dubernard G, Roseau G, Cortez A, Darai E. Accuracy of magnetic resonance imaging and rectal endoscopic sonography for the prediction of location of deep pelvic endometriosis. Hum Reprod. 2007;22(5):1457-63. (Level II evidence). View the reference
- Bazot M, Lafont C, Rouzier R, Roseau G, Thomassin-Naggara I, Darai E. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril. 2009;92(6):1825-33. (Level II evidence). View the reference
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