Parameters:
(1) transvaginal ultrasound
(2) pelvic examination
(3) dysmenorrhea (menstrual cramps)
(4) dyspareunia (deep pain during intercourse)
Criteria for a positive pelvic examination (page 930):
(1) scarring, nodularity or pain of the utersacral ligament
(2) modularity or pain in the Pouch of Douglas
(3) vaginal endometriosis
(4) painful or fixed adnexal masses
(5) fixed uterus
(6) pain on movement of the uterus
Features of a focus of endometriosis on transvaginal ultrasound:
(1) thick walls
(2) regular margins
(3) fluid homogeneous with low echogenicity
|
Ultrasound
|
Pelvic Exam
|
Dys-menorrhea
|
Dyspareunia
|
Diagnosis
|
|
positive
|
positive
|
NA
|
NA
|
ovarian
|
|
positive
|
negative
|
NA
|
NA
|
negative
|
|
negative
|
NA
|
negative
|
NA
|
negative
|
|
negative
|
NA
|
positive
|
positive
|
negative
|
|
negative
|
positive
|
positive
|
negative
|
non-ovarian
|
|
negative
|
negative
|
positive
|
negative
|
negative
|
Performance:
• The tree was accurate for ovarian endometriosis, with 100% correctly identified in the study sample and 85% in the test sample.
• Only 38% of nonovarian endometriosis were correctly identified in the study sample (12% in the test sample), with most patients thought to be nondiseased. Many of the missed cases were in the negative ultrasound and negative dysmenorrhea group.
• The milder the disease and the less involvement of key structures, the more likely it would be missed by the decision tree.
