Location, color, size, depth, and volume may predict endometriosis in lesions resected at surgery

Abstract

Objective: To correlate the diagnosis of endometriosis in lesions excised at laparoscopy with pathologic diagnosis. Design: Prospective study. Setting: U.S. government research hospital. Patient(s): Women with chronic pelvic pain thought to be due to endometriosis. Intervention(s): Excision of lesions suspicious for endometriosis. Main Outcome Measure(s): Histologic examination of lesions for color, width, depth, and location of endometriosis. Lesion colors were grouped as black, red, white, mixed color, or endometriomas. Result(s): Sixty-five women with a surgical diagnosis of endometriosis had minimal (n = 22), mild (n = 25), moderate (n = 9), or severe disease (n = 9) according to the revised American Fertility Society classification. Endometriosis was confirmed in all but seven patients with minimal and one with severe disease. Twelve other patients did not have endometriosis. Of 314 lesions excised, 189 (61%) were endometriotic. Black or red lesions were less often histologically confirmed to be endometriosis than were white lesions, mixed-color lesions or endometriomas. Lesions > 5 mm wide or deep were more likely to be endometriosis than were narrower or shallower implants. Endometriomas deeper than 1 cm were histologically confirmed to be endometriosis, and 50% of peritoneal windows contained endometriosis. Conclusion(s): White lesions, mixed-color lesions, endometriomas, and larger lesions by depth or width were more likely to be histologically confirmed endometriosis than were smaller, black, or red lesions.