Japanese Translation

Investigations

Ultrasound

A

Compared to laparoscopy, trans-vaginal ultrasound (TVS) has no value in diagnosing peritoneal endometriosis, but it is a useful tool both to make and to exclude the diagnosis of an ovarian endometrioma (Moore et al., 2002). TVS may have a role in the diagnosis of disease involving the bladder or rectum.

Systematic review of diagnostic tests

Magnetic resonance imaging

At present, there is insufficient evidence to indicate that magnetic resonance imaging (MRI) is a useful test to diagnose or exclude endometriosis compared to laparoscopy.

Blood tests

A

Serum CA-125 levels may be elevated in endometriosis. However, compared to laparoscopy,  measuring serum CA-125 levels has no value as a diagnostic tool (Mol et al., 1998).

Systematic review of diagnostic tests

Investigations to assess disease extent

GPP

If there is clinical evidence of deeply infiltrating endometriosis, ureteral, bladder, and bowel involvement should be assessed. Consideration should be given to performing MRI or ultrasound (trans-rectal and/or trans-vaginal and/or renal), with or without IVP and barium enema studies depending upon the individual circumstances, to map the extent of disease present, which may be multi-focal.

Assessment of ovarian cysts

GPP

Local guidelines for the management of suspected ovarian malignancy should be followed in cases of ovarian endometrioma. Ultrasound scanning ± serum CA-125 testing is usually used to try to identify rare instances of ovarian cancer; however, CA-125 levels can be elevated in the presence of endometriomas.

Laparoscopy

GPP

Good surgical practice is to use an instrument such as a grasper, via a secondary port, to mobilise the pelvic organs and to palpate lesions which can help determine their nodularity. It is also important to document in detail the type, location and extent of all lesions and adhesions in the operative notes; ideal practice is to record the findngs on video or DVD.

GPP	There is insufficient evidence to justify timing the laparoscopy at a specific time in the menstrual cycle, but it should not be performed during or within three months of hormonal treatment so as to avoid under-diagnosis.

B

All classification systems for endometriosis are subjective and correlate poorly with pain symptoms, but may be of value in infertility prognosis and management (Chapron et al., 2003b; D'Hooghe et al., 2003).

Evidence Level 3

B

At laparoscopy, deeply infiltrating endometriosis may have the appearance of minimal disease, resulting in an underestimation of disease severity (Koninckx et al., 1994).

Evidence Level 3

 

Supporting Documentation