Visnovsky 2008.

Study characteristics
Patient sampling	Primary objective: to determine clinical benefits of mRNA aromatase expression in entopic endometrium as a diagnostic marker of endometriosis Participants: women undergoing laparoscopy or laparotomy for pelvic pain, infertility of benign pelvic tumours Selection criteria: inclusion criteria: confirmed benign pelvic condition by pre‐operative ultrasound Study design: observational single‐gate, prospective sample collection
Patient characteristics and setting	Clinical presentation: endometriosis: pelvic pain, infertility, pelvic mass Age: mean age 39.7; SD and range not reported Number enrolled: 23 women Number available for analysis: 23 women (menstrual cycle phase not specified) Setting: university hospital ‐ O&G Department Jessenius Medical Faculty and Martin University Hospital Place of study: Martin, Czech Republic Period of study: May 2006 to August 2007 Language: English
Index tests	Index test: aromatase mRNA Description of positive case definition by index test as reported: mRNA expression by RT‐PCR, semi‐quantitative expression scored 0‐3: 0 ‐ no expression; 1 ‐ low; 2 ‐ medium; 3 ‐ high expression; technique not described; threshold ‐ low expression (score 1 and above, not pre‐specified) Examiners: not reported; unclear if were blinded to the results of reference standard Interobserver variability: not reported
Target condition and reference standard(s)	Target condition: endometriosis Prevalence of target condition in the sample: n/N = 12/23 (52%); stage not specified; controls 11 Reference standard: laparoscopy n = 17/laparotomy n = 6 + histology Description of positive case definition by reference test as reported: visual inspection confirmed by histology, rAFS staging Examiners: none stated
Flow and timing	Time interval between index test and reference standard: endometrial samples were collected at surgery Withdrawals: none reported
Comparative
Notes	Conclusion: Aromatase expression in eutopic endometrium is a good diagnostic marker for endometriosis.
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	No
Did the study avoid inappropriate exclusions?	Unclear
Was a 'two‐gate' design avoided?	Yes
		High	Unclear
DOMAIN 2: Index Test All tests
Were the index test results interpreted without knowledge of the results of the reference standard?	Unclear
If a threshold was used, was it pre‐specified?	No
Was a menstrual cycle phase considered in interpreting the index test	No
		High	Low
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	Yes
		Low	Low
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Yes
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	Yes
		Low