Abstract
Background: Endometriosis is enigmatic clinical entity which is described as the location of the endometrial tissue external of the uterine cavity. Endometriosis constitutes a serious health issue due to its high affliction of 10% of reproductive women. With limited resources in Africa, it is essential to assess whether diagnosis of endometriosis by laparoscopic visualization can be used as a substitute for histology. Objective: To correlate the diagnosis of endometriosis by laparoscopic visualization and the histological confirmation of the biopsy taken. Methods: A prospective cross sectional study with a sample size of 443 was undertaken in the diagnosis of endometriosis among Africans in Nairobi, Kenya from March 2019 to March 2021. Women undergoing laparoscopy were screened for endometriosis by visualization and a biopsy was taken for histopathology. Diagnosis of endometriosis by visualization was correlated with histological confirmed endometriosis. Results: Women with a diagnosis of endometriosis through laparoscopic visualization were found to be 77 (17.4%) and 30 (6.8%) had positive histology for endometriosis. Laparoscopic visualization diagnosis had a low positive predictive value of 39%. Conclusion: Laparoscopic visualization diagnosis had a low positive predictive value of 39% and this did not correlate with histopathologic diagnosis. It is essential to perform biopsy with histopathology for the confirmation of endometriosis.
Highlights
Endometriosis is enigmatic clinical entity which is described as the location of the endometrial tissue external of the uterine cavity
With limited resources in Africa, it is essential to assess whether diagnosis of endometriosis by laparoscopic visualization can be used as a substitute for histology
Women undergoing laparoscopy were screened for endometriosis by visualization and a biopsy was taken for histopathology
Summary
Endometriosis is a woman’s reproductive ailment, described as presence of endometriotic glands and stroma outside the endometrial cavity, mainly in the pelvic peritoneum, ovary and rectovaginal septum. Endometriosis manifests with chronic pelvic pain and infertility, and both have high prevalence of as high as 35% - 50% [2]. The understanding, diagnosis and establishment of the disease burden of endometriosis in Africa are essential for the appropriate management of this disease. There is a conception that African women are hardly inflicted with endometriosis and that is most likely due to poor diagnosis methodology [3] [4]. There is scanty literature on Africans on the endometriosis clinical presentation and the prevalence [3]. The gold standard for the diagnosis of endometriosis is laparoscopic visualization and histological confirmation and this has revolutionized the management of this disease [6] [7]. Endometriosis can mimic other pathologies such as pelvic infection, endosalpingiosis and cancer in clinical appearance and better laparoscopic optics resolution, recognition of various clinical manifestations of endometriosis and methodological assessment of the pelvic anatomy are imperative [9]
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