title: Positive predictive value of clinical diagnosis of endometriosis.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  The positive predictive value of severe dysmenorrhea with nodularity of the cul-de-sac and/or uterosacral ligament(s) was 94.0%.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110, Thailand. csophon@medicine.psu.ac.th
authors.forename: Sopon
authors.initials: S
authors.lastname: Cheewadhanaraks
authors.forename: Krantarat
authors.initials: K
authors.lastname: Peeyananjarassri
authors.forename: Kriengsak
authors.initials: K
authors.lastname: Dhanaworavibul
authors.forename: Tippawan
authors.initials: T
authors.lastname: Liabsuetrakul
mesh_terms: D000328:Adult; D004412:Dysmenorrhea / Q000209:etiology; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D012680:Sensitivity and Specificity