IS LAPAROSCOPIC VISUALIZATION SUFFICIENT FOR THE DIAGNOSIS OF ENDOMETRIOSIS?

Many times, endometriosis is diagnosed by laparoscopic visualization alone, when histopathology is not feasible due to electrosurgical ablation of lesions. Objective of this study was to evaluate the diagnostic performance of the surgeon's laparoscopic visualization as compared to histopathological diagnosis of endometriosis.

A retrospective chart review was performed for women who underwent a non-malignant gynecological surgery at a tertiary care hospital between April 2016 to March 2017. After describing frequency distribution of pertinent variables; sensitivity, specificity, predictive values and accuracy were calculated for comparison between diagnosis based on laparoscopic visualization only and histopathological report.

Among 1069 women, 96 women who had both laparoscopicvisualization for suspected endometriosis and concurrent histopathological biopsy report, were included. Mean age of women was 40 (SD 7.2) years. Many experienced abdominal/pelvic pain (41.7%), excessive menstruation (34.4%), dysmenorrhea (29.2%) and infertility (8.3%). Common sites of endometriosis were ovarian endometriomas (31.3%) and deep infiltrating endometriosis (25.0%) (uterosacral ligament [19.8%] and rectovaginal septum [14.6%]). Endometriosis was diagnosed in 82.3% women by surgeons during laparoscopic visualization and in 74.0% by histopathology. Sensitivity for laparoscopic visualization of endometriosis was 90.1% (95%CI 80.7-95.9) while specificity was 40.0% (95%CI 21.1-61.3). The positive and negative predictive values were 81.0% (95%CI 70.6-89.0), and 58.8% (95%CI 35.0-79.9), respectively; and the accuracy was 77.1% (95%CI 67.9-84.7).

Surgeons have a high probability of detecting endometriosis when it is present; while misdiagnosis is more likely to occur when endometriosis is absent. Laparoscopic visualization should be supplemented with histopathological diagnosis for good diagnostic practice.