Modified Ubess and CA-125 Endometriosis Severity Prediction Model Protocol

Abstract

Study Objective The Ultrasound-Based Endometriosis Staging System (UBESS) has demonstrated accuracy in predicting the laparoscopic skill required for maximum cytoreductive endometriosis surgery. However, UBESS does not account for the need for ureterolysis, an advanced laparoscopic skill, nor does it differentiate between isolated peritoneal disease and no disease. The Modified-UBESS and Ca-125 endometriosis severity prediction model aims to account for these short-falls by incorporating ultrasound (ovarian fixation, endometrioma, uterosacral endometriosis) and biochemical (Ca-125) markers to improve the prediction of intraoperative ureterolysis and isolated peritoneal disease, thereby improving the UBESS accuracy in predicting surgical complexity. Design This prospective study assesses the diagnostic accuracy of the endometriosis severity prediction model in predicting the ASRM endometriosis stage (American Society of Reproductive Medicine) and AGES laparoscopic skill (Australasian Gynaecological Endoscopy & Surgery) required for maximum cytoreductive surgery for women with suspected endometriosis undergoing laparoscopic surgery at Liverpool, Campbelltown and Nepean Hospital over a 5-year period. Setting N/A Patients or Participants 200 women of reproductive age with suspected endometriosis (chronic pelvic pain and/or infertility) will be recruited. Interventions Participants will undergo a standardised history and Ca-125, followed by a 5 domain TVUS (transvaginal ultrasound) by an expert sonologist. Women will be assigned a modified UBESS score, which incorporates the likelihood of requiring ureterolysis. All women will undergo laparoscopic surgery within 6 months of their TVUS and Ca-125, with ASRM stage and AGES skill recorded. Measurements and Main Results The diagnostic accuracy of our model in predicting the ASRM stage and AGES skill required for maximum cytoreductive surgery will be calculated. Conclusion If this study demonstrates that our model is effective in preoperatively predicting the ASRM stage and AGES skill required for maximum cytoreductive endometriosis surgery, after external validation, it can be implemented worldwide to reduce the risks and health care costs associated with multiple laparoscopic surgeries for women with suspected endometriosis.