A Global Shift Toward Imaging-Based Diagnosis of Endometriosis?

International survey findings suggest ultrasound has become the predominant diagnostic tool for endometriosis in many regions worldwide.

Key Points

Highlights: 

• International survey data suggest a global shift toward ultrasound- and MRI-based evaluation of endometriosis before surgery.
• Ultrasound was identified as the predominant diagnostic modality across most surveyed regions, although substantial variability in expertise and access remains.

Importance: 

• Findings suggest that non-invasive imaging is increasingly integrated into endometriosis diagnostic pathways worldwide, potentially reducing reliance on diagnostic laparoscopy.
• Training, credentialing, cost, and geographic access remain major challenges to broader implementation.

What’s done here:

• This international cross-sectional survey was conducted between September and October 2024 through FIGO and affiliated professional networks.
• A total of 360 healthcare professionals from 66 countries across six continents completed the survey.
• Participants included gynecologists, radiologists, sonographers, primary care physicians, researchers, and other clinicians involved in endometriosis care.
• The survey examined who diagnoses endometriosis, the use of ultrasound and MRI before surgery, the availability of specialist imaging services, clinician confidence in imaging interpretation, and barriers to implementing imaging-based diagnostic approaches

Key results:

• More than 90% of respondents reported that non-invasive imaging is used before surgery in their country.
• Gynecologists were identified as the primary clinicians diagnosing endometriosis worldwide.
• Ultrasound was the most frequently reported diagnostic modality, exceeding MRI, symptom-based assessment, and surgery.
• Lack of training and expertise, financial barriers, and limited accessibility were the most commonly reported obstacles to imaging-based diagnosis.

Strength and Limitations:

• Strengths are the inclusion of healthcare professionals from 66 countries and the provision of a contemporary global snapshot of endometriosis diagnostic practices.
• Limitations are the predominance of gynecologist respondents, potential participation bias toward clinicians with a particular interest in endometriosis, and substantial heterogeneity in healthcare systems and imaging practices across countries.

From the Editor-in-Chief – EndoNews

"This international survey provides a contemporary snapshot of how endometriosis is evaluated across diverse healthcare systems and suggests that non-invasive imaging has become increasingly integrated into diagnostic pathways worldwide. Ultrasound emerged as the predominant diagnostic modality, with most respondents reporting routine use of imaging before surgery, reflecting the growing role of specialist imaging in endometriosis care.

Importantly, the study highlights substantial variation in expertise, access, and confidence regarding endometriosis imaging. A considerable proportion of respondents reported difficulties distinguishing specialist endometriosis imaging from routine gynecologic ultrasound, underscoring that broader adoption of imaging-based approaches depends not only on technology availability but also on operator training and standardization.

The findings should be interpreted within the context of the study design. As a survey of healthcare professionals, the results reflect reported practice patterns and perceptions rather than objectively measured diagnostic performance, patient outcomes, or healthcare utilization. Consequently, the study cannot determine whether increased use of ultrasound and MRI translates into earlier diagnosis, reduced diagnostic delay, improved surgical planning, or better patient outcomes.

Nevertheless, the survey documents an important shift in clinical practice and highlights the growing influence of specialist imaging in the contemporary management of endometriosis. Future studies evaluating diagnostic accuracy, implementation strategies, and patient-centered outcomes will be essential to determine the clinical impact of this evolving diagnostic landscape.

Lay Summary

There has been a significant shift internationally from lesion visualization at the time of laparoscopy to non-invasive imaging approaches in the diagnosis of endometriosis, according to a new study published in the International Journal of Gynecology & Obstetrics. 

“Policies should aim to overcome barriers to uptake of imaging-based diagnostics by supporting training initiatives, reducing associated costs, and improving geographical accessibility,” the auhtors of the study said, adding that once non-invasive approaches to diagnose the disease are adopted effectively, endometriosis care will be transformed.

To assess the involvement of healthcare providers and their preferred way of reaching a diagnosis of endometriosis across international jurisdictions, a team of researchers led by Dr. M Louise Hull conducted a global cross-sectional survey-based study that they distributed through formal and informal International Federation of Gynecology and Obstetrics (FIGO) Reproductive Medicine, Endocrinology, and Infertility committee networks between September and October 2024. 

A total of 360 multinational stakeholders completed the survey. Of these, the majority (63.9%) were female, and most of them were gynecologists. Only 6.7% of survey responders were academics, while 39.2% were involved in research in some capacity. 

Endometriosis was mainly diagnosed by gynecologists.  Most respondents said that ultrasound was the main approach they used to diagnose the disease. 

The vast majority (93.6%) of those surveyed said that clinicians used non-invasive methods, mainly ultrasound, to reach a diagnosis of endometriosis before surgery in their country. 

A third of respondents said that they did not feel confident in differentiating between specialist endometriosis imaging and routine gynecological scans. 

The barriers to the uptake of imaging techniques for the diagnosis of endometriosis were access to training, cost, and accessibility. 

Finally, the respondents described "game-changing" effects of adopting non-invasive imaging in clinical care as improvements in surgical mapping before the operation and patient-centered care. However, they said that this could significantly increase clinical workloads.

“Raising awareness and addressing gaps in knowledge and skills will improve access to non-invasive diagnosis,” the auhtors concluded.

Research Source: https://pubmed.ncbi.nlm.nih.gov/41235636/