A 38-year-old woman presents with progressive, cyclic dysmenorrhoea, deep dyspareunia, and dyschezia over 3 years. Pelvic examination reveals a fixed, retroverted uterus with nodularity of the uterosacral ligaments. The CA-125 level is mildly elevated at 68 U/mL. The GOLD STANDARD for definitive diagnosis is:
- A Transvaginal ultrasound
- B Laparoscopy with biopsy ✓
- C Serum CA-125 measurement
- D MRI pelvis
Correct answer: B. Laparoscopy with biopsy
Explanation
Laparoscopy with histological confirmation of biopsy specimens is the gold standard for diagnosing endometriosis. The classic laparoscopic findings include powder-burn lesions, chocolate cysts (endometriomas), and adhesions. Transvaginal ultrasound and MRI are useful for detecting endometriomas but cannot confirm peritoneal implants or deep infiltrating disease. Serum CA-125 is neither sensitive nor specific enough for diagnosis.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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