title: Preoperative assessment and diagnosis of endometriosis: are we any closer?
abstract: OBJECTIVE
  The management of endometriosis has progressed vastly with medical treatments providing a large role in controlling endometriosis symptoms. Despite these advances we still lack an accurate noninvasive test to diagnose endometriosis. This has a large role in the delay to diagnosis, management and progression of the disease amongst a population that is choosing to conceive later.
  
  
  RESULTS
  Endometriosis is now thought to affect 1 in 10 women with patient annual healthcare costs estimated at &OV0556;9579. The diagnosis of this disease is still delayed by an average of 6-9 years allowing disease and symptom progression. Researchers have assessed a wide variety of noninvasive markers from urinary derivatives to MRI. There has been limited success in producing a highly sensitive and specific preoperative test for endometriosis. Novel markers such as miRNA provide the most encouraging diagnostic accuracy.
  
  
  CONCLUSIONS
  The development of a noninvasive accurate marker for endometriosis is a research target and priority of the European Society of Human Reproduction and Embryology. The current markers in use have moderate sensitivity and sensitivity. The inflammatory basis for the disease underpins many biomarkers but also many other concomitant diseases reducing accuracy and increasing false positive results.
authors.affiliation: aCentre for Reproductive Medicine, St Bartholomew's Hospital, Barts Health NHS Trust bWomen's Health Research Unit, Barts and the London School of Medicine and Dentistry, Whitechapel, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Hirsch
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Davis
mesh_terms: D015415:Biomarkers / Q000097:blood; D057210:Delayed Diagnosis / Q000517:prevention & control*; D004715:Endometriosis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D005260:Female; D020869:Gene Expression Profiling; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control*; D036341:Intercellular Signaling Peptides and Proteins; D008403:Mass Screening / Q000458:organization & administration*; D008487:Medical History Taking; D035683:MicroRNAs / Q000097:blood*; D017699:Pelvic Pain / Q000209:etiology*; D012680:Sensitivity and Specificity; D016387:Women's Health / Q000592:standards*
chemical_list: D015415:Biomarkers; D036341:Intercellular Signaling Peptides and Proteins; D035683:MicroRNAs