Positive Predictive Value of Clinical Diagnosis of Endometriosis
Sopon Cheewadhanaraks MD*, Krantarat Peeyananjarassri MD*, Kriengsak Dhanaworavibul MD*, Tippawan Liabsuetrakul MD, PhD*
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University
Objective : To determine the positive predictive value of the combined symptoms of severe dysmenorrhea with
the sign of tenderness and/or nodularity of the cul-de-sac and/or uterosacral ligament(s) in diagnosing
endometriosis clinically.
Materials and Methods : In this prospective study, 116 patients with severe dysmenorrhea, after excluding
urinary and gastrointestinal disease, underwent pelvic examination by the same investigator. Women having
adnexal mass on pelvic examination were excluded. Tenderness, and also nodularity, of the cul-de-sac, right
and left uterosacral ligament were recorded separately. The laparoscopist did not know the findings of the
pelvic examination. The diagnosis of endometriosis was made visually when lesions were typical and all
other lesions were biopsied.
Results : The prevalence of endometriosis was 78.4%. Tenderness, nodularity, tenderness and nodularity,
and also tenderness or nodularity of cul-de-sac and/or uterosacral ligament(s) were all statistically
significantly associated with the presence of endometriosis (P = .048, .005, .004, and .004 respectively). The
positive predictive values were 85.5%, 94.0%, 94.6% and 86.7%, respectively.
Conclusion : The positive predictive value of severe dysmenorrhea with nodularity of the cul-de-sac and/or
uterosacral ligament(s) was 94.0%.
Keywords : Diagnosis, Dysmenorrhea, Endometriosis
