Strengths and limitations
An important strength of our study is the fact that this is, to our knowledge, the first study which compared solitary and combinations of anatomical locations in correlation to pain reporting and created ROC curves to determine if certain symptoms could predict the presence of endometriosis in specific compartments. Because of the use of the EQUSUM, data was collected in a uniform way, making it easy to analyse the data without inconsistencies in the datafile.
A limitation of this study is the fact that no medication usage was registered and the NRS pain reporting is pre-operative in patients with and without medication. However, a subgroup analysis within the study from Montanari et al. (5) showed that preoperative use of hormonal therapy did not influence the associations and correlations for reported pain symptoms described by the Enzian. Only a weak correlation was found with the rASRM and dysmenorrhoea when patients used hormonal therapy. So, medication use is obviously of influence, but it seems to have little effect on the results.
A different limitation of this study is that no pathology results are recorded. The endometriosis is staged on the clinical subjective measure of the surgeon and not confirmed by the pathologist. However, there is no debate of a C1 nodule, whether this is DE of not.