IS THE USE OF A NON INVASIVE MOBILE APPLICATION AN EFFECTIVE WAY TO SCREEN WOMEN FOR ENDOMETRIOSIS DURING THE COVID-19 PANDEMIC?

ABSTRACT

OBJECTIVE: The purpose of this study is to determine the positive predictive value (PPV) of diagnosis for endometriosis by the Nezhat Endometriosis Advisor (NEA) mobile application to serve as a screening tool MATERIALS AND METHODS: A retrospective cohort study was conducted at a university-affiliated private practice. Inclusion criteria were women with no previous surgical diagnosis of endometriosis who also completed an endometriosis assessment using the application. Patients with symptoms desiring definitive diagnosis and treatment of endometriosis then underwent laparoscopic surgery once surgeries were once again allowed. The diagnosis of endometriosis was confirmed visually by a surgeon specialized in treating endometriosis and also through biopsy sent to pathology. The primary outcome measured was the PPVof NEA mobile application questionnaire to the surgical diagnoses of endometriosis. RESULTS: A total of 100 patients met the inclusion criteria for this study. 95% of the patients whose score on the app was 90% or above, had a surgical pathology confirmed diagnosis of endometriosis (PPV 95%). CONCLUSIONS: NEA mobile application questionnaire has a high PPVof 95% for diagnosing endometriosis and can help identify a patient population that may require surgical treatment for pelvic pain or unexplained infertility. This will be helpful as it may lead to earlier diagnosis and management of endometriosis. Patients can reduce risk exposure of COVID-19 by avoiding multiple medical office visits. The COVID-19 pandemic has also decreased the availability of healthcare for many, and they may suffer for a long time with pain or infertility before a diagnosis is made. The mobile application is a possible alternative method to assess risk of endometriosis while avoiding risk of COVID-19 exposure. Patients can be medically treated based on symptoms and application results until surgery can be performed. With further research, the application has the potential to be the diagnostic measure of endometriosis. More research is needed to determine the continued accuracy of the application in different patient population and demographics IMPACT STATEMENT Endometriosis is ectopic uterine lining growing outside the uterus which causes pain and infertility. Currently, definitive diagnosis is with pelvic laparoscopic surgery, as no screening test is widely available or accepted. The Coronavirus Disease 2019 (COVID-19) pandemic due to the infectious pathogen Severe Acute Respiratory Syndrome Coronavirus 2 has altered ambulatory and inpatient health care. For several months commencing March 2020, non-emergent surgeries came to an abrupt hault due to the COVID- 19 pandemic. Many patients who were scheduled to have diagnostic laparoscopies for suspected endometriosis were not able to have their surgeries performed. As an alternative NEA was utilized to determine the likelihood of endometriosis based on self-answered questionnaires about experienced symptoms. The mobile app is free and available for patients worldwide. Patients with a high probability of endometriosis can be treated medically until surgery resume.