Faisabilité et apport de la tomographie par émission de position (TEP) dans la localisation préopératoire des lésions d’endométriose

Introduction: Endometriosis is a chronic inflammatory disease, responsible for cyclic pelvic pain, particularly during menstruation. Surgery is an option to treat endometriosis and the surgeon needs a precise cartography of the lesions before planning surgery. MRI and endovaginal ultrasounds are commonly used to assess the presence and localization of lesions, but sensitivity and specificity remain limited. Some case reports have reported the fixation of endometriosis in 18F-Fluorodesoxyglucose Positron Emission Tomography (18F-FDG PET/CT), and subsequent studies confirmed the metabolic activity of endometriotic lesions on PET. Therefore, we aimed to evaluate the feasibility and benefits of PET scan for the evaluation of endometriosis before surgical intervention. Method: Patients with surgical indication for endometriosis had a PET scan during menstruation, before intervention. Lesions were described by localization, volume, and SUVmax. Then, gynecologists described lesions during intervention by localization, number, volume, and inflammatory degree. Results: A total of 15 patients in University Hospitals of La Réunion were included. However, only 5 completed the full research protocol, which required undergoing all three key procedures: Magnetic Resonance Imaging (MRI), a Positron Emission Tomography (PET) scan during menstruation, and subsequent surgical intervention. 18F-FDG PET imaging detected fewer lesions compared to surgery and to MRI though results were not significant (p-value = 0.06). Diagnostic performances varied by lesion localization, with PET demonstrating generally good specificity but limited sensitivity. Conclusion: Feasibility of 18-FDG PET scan for detecting endometriosis lesions during menstruation is poor, with technical and human limitations. Diagnostic performances are mainly insufficient for preoperative screening of lesions.