Significance of symptom and physical sign to diagnosis of deeply infiltrating endometriosis

Abstract

To study the significance of pain symptoms and physical signs to diagnosis of deeply infiltrating endometriosis (DIE). Totally 500 patients with laparoscopic diagnosis of endometriosis were studied retrospectively and divided into two groups depending on the existance of DIE. The pain symptoms and gynecological physical signs were recorded detail, and the correlation with diagnose of DIE were analyzed. (1) The significance of pain symptoms: the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and OR, 95% CI of each pain symptom were: dysmenorrhae (90.5%, 37.2%, 59.6%, 79.3%, 5.66, 3.46-9.28), chronic pelvic pain (35.2%, 82.6%, 67.4%, 55.4%, 2.58, 1.70-3.91), dyspareunia (46.2%, 80.6%, 70.7%, 59.6%, 3.56, 2.39-5.32), dyschezia (51.0%, 73.7% , 66.5% , 59.5%, 2.91, 2.00- 4.24), respectively. (2) Pelvic physical examination: the sensitivity, specificity, PPV and NPV of each physical sign were: fixed uterine: 73.6%, 71.2%, 79.5%, 64.0%; fixed ovarian cyst: 94.1%, 20.3%, 63.3%, 70.0%; uterosacral ligaments nodule: 47.1%, 97.5%, 96.6%, 54.9%; uterosacral ligaments nodule with tenderness: 81.7%, 75.0%, 83.1%, 73.2%; rectovaginal septum nodule: 32.2%, 100.0%, 100.0%, 49.4%; rectovaginal septum nodule with tenderness: 32.2%, 100.0%, 100.0%, 49.4%; blue nodule in posterior vaginal forni: 14.9%, 100.0%, 100.0%, 43.7%. In the symptoms, the dysmenorrheal has the highest sensitivity and NPV for the diagnosis. And chronic pelvic pain has the highest specificity, and dysparaunia has the highest PPV for the diagnosis. In pelvic vaginal examination, fixed uterine, fixed ovarian cyst and the nodule on uretosarcal ligment and rectovaginal septum with tenderness, the blue lesion on posterior fornix have the strong significance for DIE. So record the symptom detail and careful digital vaginal examination, especially the vaginal-recto-abdominal examination could improve the diagnosis DIE obviously before procedure.