Diagnosis of Endometriosis: The Surgeon's Eye Compared to Histopathology

Dana C. McKee, Marlene Girardo, Megan Wasson
In: Journal of Gynecologic Surgery · 2023 · vol. 39(5) , pp. 235–239 · doi:10.1089/gyn.2023.0032 · W4384008515
Diagnostic accuracy OA: closed CC0 ⤵ 2 in-corpus citations
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This study found that visual endometriosis detection during surgery has moderate sensitivity and specificity, with low positive predictive value, suggesting a role for complete peritonectomy due to atypical lesions and invisible disease.

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Abstract

Objective: The aim of this research was to evaluate intraoperative visual detection of endometriosis compared to final histopathologic diagnosis based on lesion type. Materials and Methods: This prospective clinical study at a tertiary-care, academic medical center involved 77 patients who had surgery by high-volume endometriosis surgeons for suspected endometriosis. Pelvic peritonectomy was performed with documentation of visual presence or absence of endometriosis and lesion type. Powder burn lesions were defined as typical lesions. White scarring, clear vesicles, red flame, and peritoneal pockets were defined as atypical lesions. Results: Of 1069 peritoneal specimens, there was visual detection of endometriosis in 352 (32.93%). Endometriosis was confirmed on histopathologic evaluation of: powder-burn, 65.8%; white scarring, 51.6%; clear vesicles, 45.7%; red-flame, 39.1%; and peritoneal pockets, 28.9% ( p = 0.003). Additionally, 11.3% of specimens with no visible endometriosis demonstrated a positive histopathologic diagnosis. Overall sensitivity was 68.36%; specificity was 78.15%; positive predictive value (PPV) was 49.72%; and negative predictive value was 88.66%. All lesions had high specificity (powder-burn, 96.20%; white scarring, 91.34%; clear vesicles; 92.54%; red-flame, 97.84%; and peritoneal pockets; 95.91%). PPV depended on lesion type (powder-burn, 65.75%; white scarring, 51.61 %; clear vesicles, 45.74%; red-flame, 39.13% peritoneal pockets, 28.95%). Conclusions: Visual detection of endometriosis during surgical evaluation is not reliable. The potential for atypical-lesion appearance and disease not macroscopically visible suggests a role for complete pelvic peritonectomy. (J GYNECOL SURG 39:235)

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Condition tags

endometriosis

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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