Modified Ubess and CA-125 Endometriosis Severity Prediction Model – Preliminary Results

Study Objective The Ultrasound-Based Endometriosis Staging System (UBESS) does not account for the need for ureterolysis, nor does it differentiate between isolated peritoneal disease and no disease. The Modified-UBESS (M-UBESS) and Ca-125 endometriosis severity prediction model aims to account for these short-falls by incorporating ultrasound (endometrioma, Pouch of Douglas ‘POD’ obliteration, uterosacral endometriosis & ovarian fixation) and Ca-125 to improve the prediction of intraoperative ureterolysis and isolated peritoneal disease, improving the UBESS accuracy in predicting surgical complexity. Design Prospective multicentre study assesses the accuracy of the endometriosis severity prediction model in predicting the AGES laparoscopic skill (Australasian Gynaecological Endoscopy & Surgery) required for maximum cytoreductive surgery for women with suspected endometriosis undergoing laparoscopic surgery at Liverpool, Campbelltown and Nepean Hospital over a 5-year period (Feb 2020). Setting N/A. Patients or Participants 63/200 women of with suspected endometriosis have been recruited thus far. Interventions Participants underwent a Ca-125 and a 5-domain transvaginal ultrasound by an expert sonologist according to the International Deep Endometriosis Analysis criteria and were assigned a M-UBESS score. All women then underwent laparoscopic surgery within 6 months, with an AGES skill recorded. Measurements and Main Results M-UBESS accuracy in predicting a generalist (level I-III) & advanced (level IV-VI) AGES level was 68.25% (p=0.044) & 76.19% (p=0.003) respectively. Ultrasound markers including endometrioma, POD obliteration, uterosacral endometriosis and fixed ovaries predicted ureterolysis in 79.37% (p=0.005), 77.78% (p=0.004), 74.60% (p=0.063) and 53.97% (p=0.137) respectively. CA125<30 predicted low r-ASRM and generalist AGES level in 73.33% and 46.67% respectively and distinguished between nil disease and r-ASRM I-II (sensitivity 75%). Conclusion Ultrasound markers (endometrioma, POD obliteration, uterosacral endometriosis & ovarian fixation) and CA-125 improve the prediction of intraoperative ureterolysis and isolated peritoneal disease. Further recruitment is required to determine whether the incorporation of these markers into the M-UBESS model improves UBESS accuracy in predicting surgical complexity. The Ultrasound-Based Endometriosis Staging System (UBESS) does not account for the need for ureterolysis, nor does it differentiate between isolated peritoneal disease and no disease. The Modified-UBESS (M-UBESS) and Ca-125 endometriosis severity prediction model aims to account for these short-falls by incorporating ultrasound (endometrioma, Pouch of Douglas ‘POD’ obliteration, uterosacral endometriosis & ovarian fixation) and Ca-125 to improve the prediction of intraoperative ureterolysis and isolated peritoneal disease, improving the UBESS accuracy in predicting surgical complexity. Prospective multicentre study assesses the accuracy of the endometriosis severity prediction model in predicting the AGES laparoscopic skill (Australasian Gynaecological Endoscopy & Surgery) required for maximum cytoreductive surgery for women with suspected endometriosis undergoing laparoscopic surgery at Liverpool, Campbelltown and Nepean Hospital over a 5-year period (Feb 2020). N/A. 63/200 women of with suspected endometriosis have been recruited thus far. Participants underwent a Ca-125 and a 5-domain transvaginal ultrasound by an expert sonologist according to the International Deep Endometriosis Analysis criteria and were assigned a M-UBESS score. All women then underwent laparoscopic surgery within 6 months, with an AGES skill recorded. M-UBESS accuracy in predicting a generalist (level I-III) & advanced (level IV-VI) AGES level was 68.25% (p=0.044) & 76.19% (p=0.003) respectively. Ultrasound markers including endometrioma, POD obliteration, uterosacral endometriosis and fixed ovaries predicted ureterolysis in 79.37% (p=0.005), 77.78% (p=0.004), 74.60% (p=0.063) and 53.97% (p=0.137) respectively. CA125<30 predicted low r-ASRM and generalist AGES level in 73.33% and 46.67% respectively and distinguished between nil disease and r-ASRM I-II (sensitivity 75%). Ultrasound markers (endometrioma, POD obliteration, uterosacral endometriosis & ovarian fixation) and CA-125 improve the prediction of intraoperative ureterolysis and isolated peritoneal disease. Further recruitment is required to determine whether the incorporation of these markers into the M-UBESS model improves UBESS accuracy in predicting surgical complexity.