Diagnosis of Stage I Endometriosis: Comparing Visual Inspection to Histologic Biopsy Specimen

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This study compared the diagnostic accuracy of visual inspection of the pelvic cavity with histologic biopsy specimens for identifying stage I endometriosis.

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Abstract

Study objectiveTo evaluate positive predictive value (PPV) of visual diagnosis at laparoscopy compared with biopsy findings according to severity of endometriosis.DesignRetrospective study (Canadian Task Force classification II-2).SettingAcademic referral center.PatientsWomen who underwent laparoscopic biopsies for suspected endometriosis.InterventionsA total of 238 biopsy specimens (73 endometriomas and 165 peritoneal implants) were taken from 104 patients undergoing laparoscopy for evaluation of chronic pelvic pain thought to be caused by endometriosis.Measurements and main resultsAccuracy of laparoscopic findings compared with histology-proved endometriosis by severity of disease and location of endometriotic lesions. Overall PPV per patient was 86.5%, which was 75.8% for stage I disease compared with 89.7%, 100%, and 90.6%, respectively, for disease stages II to IV (p = .037). The PPV per biopsy specimen of stages I to IV endometriosis was 66.1%, 78.0%, 92.0%, and 81.1%, respectively (.049). When endometriomas and peritoneal biopsy specimens were analyzed separately, no difference in PPV existed (79% vs 77%; p = .67).ConclusionHigh overall PPV existed in our study, especially in patients with advanced disease. The PPV per patient was higher than the PPV per biopsy specimen indicating that ability to diagnose endometriosis may be improved by performing multiple biopsies. This is particularly true in stage I where failure to confirm may be greatest.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Adult Biopsy Endometriosis Female Humans Predictive Value of Tests Retrospective Studies

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