CONTEXT AND OBJECTIVE: Diagnoses of endometriosis are based on observation of endometriotic lesions by means of laparoscopy, along with the pathological fi ndings. The aim of this study was to evaluate the sensitivity and specifi city of the macroscopic fi ndings in relation to the histopathological fi ndings. More specifi cally, we aimed to test the effi cacy of laparoscopy alone for diagnosing endometriosis and to evaluate the laterality of endometriosis among the study population. DESIGN AND SETTING:Cross-sectional study on women undergoing laparoscopy due to pelvic pain or infertility, in the Gynecology Department of Hospital Santa Cruz in Curitiba, Paraná, Brazil, and Pontifícia Universidade Católica do Paraná. METHODS:A total of 976 patients underwent laparoscopy and biopsy due to pelvic pain and/ or infertility. We analyzed the laparoscopic and histopathological fi ndings from patients with pelvic endometriosis (n = 468) and patients without endometriosis (n = 508). RESULTS:In 468 (47.95%) of the cases, the clinical and laparoscopic fi ndings were consistent with endometriosis, and this was confi rmed histopathologically in 337 (34.5%). Among the remaining 508 patients, although the laparoscopy was performed for other reasons relating to acute pelvic pain, eight were diagnosed with endometriosis from histopathological examination of the pelvic specimens obtained. Therefore, endometriosis was confi rmed in 345 patients (35.3%). In comparison with the histopathology, laparoscopy alone presented 97.68% sensitivity, 79.23% specifi city, 72% positive predictive value and 98.42% negative predictive value.CONCLUSION: Laparoscopy should be used in conjunction with histopathology for diagnosing endometriosis.