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Results show markedly higher questionnaire-derived scores in EMS-positive cases and strong diagnostic performance (sensitivity 0.924, specificity 0.917), suggesting questionnaires can reduce diagnostic delay.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/non-invasive-diagnosis-of-endometriosis-by-questionnaires-in-patients-using-contraception/461545/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/non-invasive-diagnosis-of-endometriosis-by-questionnaires-in-patients-using-contraception/461545.png","ImageObject",300,407,{"name":42,"@type":43},"jay","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-08","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the purpose of using questionnaires for endometriosis diagnosis in this study?","Question",{"text":63,"@type":64},"The study tests whether questionnaire-based assessment of endometriosis-associated pain can enable non-invasive prediction of the disease, particularly for patients using hormonal contraception.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How were participants evaluated and how was endometriosis confirmed?",{"text":68,"@type":64},"Women with suspected endometriosis answered two questionnaires, then underwent physical examination and transvaginal ultrasound; suspected deep infiltrating endometriosis was additionally assessed with MRI, and final diagnosis was confirmed by histological examination.",{"name":70,"@type":61,"acceptedAnswer":71},"What diagnostic accuracy did the decision tree achieve?",{"text":72,"@type":64},"The decision tree showed sensitivity of 0.924 and specificity of 0.917, with a positive predictive value (PPV) of 0.924 and a negative predictive value (NPV) of 0.917, indicating a very good diagnostic test.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},461545,1790977259,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":113},3985747858866,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Article  \nNon-Invasive Diagnosis of Endometriosis by Questionnaires in Patients Using Contraception  \nFelix Zeppernick 1,†, Samira Balimuttajjo 1,†, Christian Schorr 2, Florian Sibelius 2, Manuela Schuler 2, Sebastian Harth 3, Sarah Seeger 1, Anna Löffelmann 1, Muhammad A. Riaz 1, Ivo Meinhold-Heerlein 1 and Lutz Konrad 1, *  \nAcademic Editors: Alberto Revelli, Arrigo Fruscalzo and Anis Feki  \nReceived: 6 October 2025  \nRevised: 8 December 2025  \nAccepted: 17 December 2025  \nPublished: 20 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Institute of Gynecology and Obstetrics, Faculty of Medicine, Justus Liebig University Giessen, Feulgenstr. 10-12, 35392 Giessen, Germany; [felix.zeppernick@gyn.med.uni-giessen.de](felix.zeppernick@gyn.med.uni-giessen.de) (F.Z.);  \n[samira.s.balimuttajjo@med.uni-giessen.de](samira.s.balimuttajjo@med.uni-giessen.de) (S.B.); [anna.loeffelmann@paediat.med.uni-giessen.de](anna.loeffelmann@paediat.med.uni-giessen.de) (A.L.);  \n[muhammad.a.riaz@gyn.med.uni-giessen.de](muhammad.a.riaz@gyn.med.uni-giessen.de) (M.A.R.);  \n[ivo.meinhold-heerlein@gyn.med.uni-giessen.de](ivo.meinhold-heerlein@gyn.med.uni-giessen.de) (I.M.-H.)  \n2 Deutsches Forschungszentrum für Künstliche Intelligenz GmbH, DFKI Saarland Informatics Campus D3.2, 66123 Saarbrücken, Germany; [christian.schorr@dfki.de](christian.schorr@dfki.de) (C.S.); [florian.sibelius@dfki.de](florian.sibelius@dfki.de) (F.S.); [manuela.schuler@dfki.de](manuela.schuler@dfki.de) (M.S.)  \n3 Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Justus Liebig University Giessen, 35390 Giessen, Germany; [sebastian.harth@radiol.med.uni-giessen.de](sebastian.harth@radiol.med.uni-giessen.de)  \n* Correspondence: [lutz.konrad@gyn.med.uni-giessen.de](lutz.konrad@gyn.med.uni-giessen.de)[ ](lutz.konrad@gyn.med.uni-giessen.de)† These authors contributed equally to this work.  \nAbstract  \nBackground/Objectives: The assessment of endometriosis (EMS)-associated pain is important, but only very few studies address the potential use of questionnaires for non-invasive prediction of the disease. Methods: In a prospective observational study from 2016 to 2024 with patients (n = 228) using hormonal contraception, all women with suspected EMS answered two questionnaires and were examined physically and with transvaginal ultrasound (TVUS). If deep infiltrating EMS (DIE) was suspected, magnetic resonance imaging (MRI) was performed. EMS diagnosis was confirmed by histological examination. Statistical analysis was mainly performed using 2 × 2 contingency tables. The decision tree was created manually. Results: The mean numerical rating scales (NRSs) of EMS-positive compared to EMS-negative patients were ~4-fold higher (4.45 and 1.15, respectively) . Patients with EMS have, significantly, ~3 times more significant parameters compared to patients without EMS (18.5 and 5.9, respectively) . In combination with dysuria and lightning-like pain, this resulted in very good prediction. A decision tree yielded a sensitivity of 0.924, a specificity of 0.917, a positive predictive value (PPV) of 0.924, a negative predictive value (NPV) of 0.917, and a positive likelihood ratio of 11.2, indicating a very good diagnostic test. There is no typical endometriosis pain, but various pain patterns are predictive of EMS. Conclusions: Thus, a reliable non-invasive EMS diagnosis by questionnaires is possible and could reduce the delay in the detection of EMS.  \nKeywords: endometriosis; pelvic pain; neuropathic pain; PainDETECT; prediction models; pre-operative diagnosis; questionnaire; contraception  \n1. Introduction  \nEndometriosis (EMS) is a disease defined by the implantation and growth of endometrial tissue outside the uterine cavity [1] . The disease can last for decades, mainly characterized by pain, usually i","cbCaieqoud3TBf4b","https://ap.wps.com/l/cbCaieqoud3TBf4b","pdf",375051,12,"English","# Abstract\n# Keywords\n# 1. Introduction","[{\"question\":\"What is the purpose of using questionnaires for endometriosis diagnosis in this study?\",\"answer\":\"The study tests whether questionnaire-based assessment of endometriosis-associated pain can enable non-invasive prediction of the disease, particularly for patients using hormonal contraception.\"},{\"question\":\"How were participants evaluated and how was endometriosis confirmed?\",\"answer\":\"Women with suspected endometriosis answered two questionnaires, then underwent physical examination and transvaginal ultrasound; suspected deep infiltrating endometriosis was additionally assessed with MRI, and final diagnosis was confirmed by histological examination.\"},{\"question\":\"What diagnostic accuracy did the decision tree achieve?\",\"answer\":\"The decision tree showed sensitivity of 0.924 and specificity of 0.917, with a positive predictive value (PPV) of 0.924 and a negative predictive value (NPV) of 0.917, indicating a very good diagnostic test.\"}]","Non-Invasive Diagnosis of Endometriosis by Questionnaires in Patients Using Contraception | PDF",1790761841]