Agreement between the preoperative findings and the operative diagnosis in patients with deep endometriosis

Introduction During the evaluation of patients with endometriosis, recognizing the location and characteristics of lesions is fundamental to define the type and evaluate the response of treatment, as well as for the preoperative surgical planning. However, the non-invasive diagnostic tests have specific limitations making the diagnostic laparoscopy been recommended as a tool necessary for the diagnosis of endometriosis lesions despite the high cost and the risks involved in this procedure.

To evaluate the feasibility of mapping endometriosis lesions using clinical signs and image evaluation, comparing the pre- and postoperative findings of patients submitted to surgical treatment.

A retrospective and prospective study included all patients who underwent surgical treatment for deep endometriosis between March 2011 and November 2014, at two centers of endometriosis in Rio de Janeiro. The positive finds registered during the clinical and image evaluation were compared with the surgical and histopathological results using a new instrument: the Lasmar’s MAP of endometriosis

46 patients were included, age ranging from 23 to 47 years. For each site of endometriosis lesions, sensitivity, specificity, positive and negative predictive value, the positive and negative likelihood ratios and accuracy were calculated.

The results show a high sensitivity, specificity and accuracy of the preoperative clinical evaluation to identify the main sites of endometriosis lesions without the use of diagnostic laparoscopy. Similar content being viewed by others

Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E (2005) ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20:2698–2704 Somigliana E, Infantino M, Benedetti F, Arnoldi M, Calanna G, Ragni G (2006) The presence of ovarian endometriomas is associated with a reduced responsiveness to gonadotropins. FertilSteril 86:192–196 Macer ML, Taylor HS (2002) Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. ObstetGynecolClin North Am 39:535–549 Roman JD (2010) Surgical treatment of endometriosis in private practice: cohort study with mean follow-up of 3 years. J Minim Invasive Gynecol 17(1):42–46 Chapron C, Fauconnier A, Dubuisson JB, Barakat H, Vieira M, Bréart G (2003) Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease. Human Reprod 18(4):760–766 Bulun SE (2009) Endometriosis. N Engl J Med 15(360):268–279 Benbara A, Fortin A, Martin B, Palazzo L, Le Tohic A, Madelenat P, Yazbeck C (2008) Surgical and functional results of rectosigmoidal resection for severe endometriosis. GynecolObstetFertil 36(12):1191–1201 Lasmar RB, Lasmar BP, Pillar C (2012) Diagram to map the locations of endometriosis. Int J Gynaecol Obstet 118(1):42–46 Bazot M, Detchev R, Cortez A, Amouyal P, Uzan S, Darai E (2003) Transvaginalsonography and rectal endoscopic sonography for the assessment of pelvic endometriosis: a preliminary comparison. Hum Reprod 18(8):1686–1692 Guerriero S, Ajossa S, Gerada M, D’Aquila M, Piras B, Melis GB (2007) Tenderness-guided transvaginal ultrasonography: a new method for the detection of deep endometriosis in patients with chronic pelvic pain. Fertil Steril 88(5):1293–1297 Goncalves MODC, Podgaec S, Dias JA, Gonzalez Jr, Abrao M (2010) Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Human Reproduction 25(3):665–671 Medeiros LR, Rosa MI, Silva BR, Reis ME, Simon CS, Dondossola ER, da CunhaFilho JS (2014) Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet Abrao MS, Gonçalves MO, Dias JA Jr, Podgaec S, Chamie LP, Blasbalg R (2007) Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod 22(12):3092–3097 Poncelet C, Ducarme G (2007) Endometriosis: good practice rules for diagnostic laparoscopy. J Gynecol Obstet Biol Reprod 36(2):135–140 Eskenazi B, Warner M, Bonsignore L, Olive D, Samuels S, Vercellini P (2001) Validation study of nonsurgical diagnosis of endometriosis. Fertil Steril 76(5):929–935 Hudelist G, Ballard K, English J, Wright J, Banerjee S, Mastoroudes H, Thomas A, Singer CF (2011) Transvaginal sonography vs. clinical examination in the preoperative diagnosis of deep infiltrating endometriosis. J. Ultrasound Obstet Gynecol 37(4):480–487 Carneiro MM, Filogônio ID, Costa LM, de Ávila I, Ferreira MC (2013) Clinical prediction of deeply infiltrating endometriosis before surgery: is it feasible? A review of the literature. Biomed Res Int 564153 Chapron C, Dubuisson JB, Pansini V, Vieira M, Fauconnier A, Barakat H, Dousse TB (2002) Routine clinical examination is not sufficient for diagnosing and locating deeply infiltrating endometriosis. J Am Assoc Gynecol Laparosc 9(2):115–119 Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest None. Rights and permissions About this article Cite this article Barcellos, M.B., Lasmar, B. & Lasmar, R. Agreement between the preoperative findings and the operative diagnosis in patients with deep endometriosis. Arch Gynecol Obstet 293, 845–850 (2016). https://doi.org/10.1007/s00404-015-3892-x Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-015-3892-x