The elusive diagnostic test for endometriosis.

The prevalence of endometriosis in the general population is hard to define. However, it is noted to be quite high in patients with infertility or chronic pelvic pain. Laparoscopy is considered to be the “gold” standard for the diagnosis of endometriosis. Although many attempts have been made to use clinical, imaging, and serum markers to arrive at a diagnosis without surgery, so far none have proven clinically useful on their own. The value of a nonsurgical diagnostic test is even more critical if medical therapy is considered to be as effective as surgical therapy. In this way, a patient can avoid surgery altogether. There is a certain degree of misclassification with all diagnostic tests. The clinician must decide if the clinical and economic consequences of such misclassification are acceptable.