Using location, color, size, and depth to characterize and identify endometriosis lesions in a cohort of 133 women

OBJECTIVE: To correlate histology with endometriosis characteristics. DESIGN: Secondary data analysis. SETTING: Government research hospital. PATIENT(S): One hundred thirty-three women with chronic pelvic pain and endometriosis who underwent laparoscopic surgery between 1999 and 2004. INTERVENTION(S): Laparoscopic excision of lesions, including recording of lesion characteristics and surgical impression of the lesions. MAIN OUTCOME MEASURE(S): All biopsies were sent for histological examination for endometriosis, and surgical and histological findings were compared. RESULT(S): Three hundred fifty-seven of 544 lesions believed to be endometriosis by the surgeon had positive histology. Mixed-color lesions most commonly contained endometriosis (76%), with the percentage of positive lesions being similar between single-color groups. Among subtle (red or white) lesions, 58% (164/283) were positive for endometriosis. Thirty women had only red or white lesions, and 18 (60%) had at least one lesion positive for endometriosis. Lesions were most commonly located in the cul-de-sac (64%), utero-sacral ligaments (68%), and ovarian fossa (70%). CONCLUSION(S): Wide, deep, mixed-color lesions in the cul-de-sac, the ovarian fossa, or the utero-sacral ligaments had the highest frequency of endometriosis. More than half of subtle lesions had endometriosis. These results should be considered when diagnosing endometriosis.