Accuracy of laparoscopy for assessing patients with endometriosis

Abstract

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.

History, pelvic examination findings and mobility of ovaries as a sonographic marker to detect pelvic adhesions with fixed ovaries

“…A study by de Almeida et al 19 found associations between endometriosis and dysmenorrhea of 33% with stage I, 33.5% with stage II, 39% with stage III and 50% association with stage IV. Similarly, Matorras et al 20 failed to identify any specific pain symptoms significantly associated with endometriosis.…”

“…A study by de Almeida et al . found associations between endometriosis and dysmenorrhea of 33% with stage I, 33.5% with stage II, 39% with stage III and 50% association with stage IV.…”

An evidence‐based approach to assessing surgical versus clinical diagnosis of symptomatic endometriosis

“…These criteria were established before appreciation of the prevalence of non‐blue and/or black lesions and without understanding of the natural history of superficial peritoneal endometriosis lesions. As shown in Table , a survey of studies that evaluated the accuracy of laparoscopic identification reveals that as many as 67% of lesions considered to be endometriosis on visual inspection were not confirmed histologically . The potential for false positives was generally higher at stages I and II in comparison with III and IV, although there is an apparent decrease in PPV between stages III and IV.…”

“…Endometriosis was confirmed by histologic evidence of both endometrial glands and stroma for all studies except Almeida Filho et al. (in which the presence of glands and stroma was not specified) and Stratton et al. (in which the presence of endometrial glands or stroma was required).…”

Total laparoscopic hysterectomy with obliterated anterior cul-de-sac

“…Endometriosis is the most common indication for operative laparoscopy and is frequently encountered as a secondary finding during laparoscopy [3], [4]. The ovaries, the posterior leaf of the broad ligament, and the posterior cul-de-sac are the most common locations of endometriosis [5].…”