Diagnosis of Endometriosis: The Surgeon's Eye Compared to Histopathology

Objective: The aim of this research was to evaluate intraoperative visual detection of endometriosis compared to final histopathologic diagnosis based on lesion type. Materials and Methods: This prospective clinical study at a tertiary-care, academic medical center involved 77 patients who had surgery by high-volume endometriosis surgeons for suspected endometriosis. Pelvic peritonectomy was performed with documentation of visual presence or absence of endometriosis and lesion type. Powder burn lesions were defined as typical lesions. White scarring, clear vesicles, red flame, and peritoneal pockets were defined as atypical lesions. Results: Of 1069 peritoneal specimens, there was visual detection of endometriosis in 352 (32.93%). Endometriosis was confirmed on histopathologic evaluation of: powder-burn, 65.8%; white scarring, 51.6%; clear vesicles, 45.7%; red-flame, 39.1%; and peritoneal pockets, 28.9% (p = 0.003). Additionally, 11.3% of specimens with no visible endometriosis demonstrated a positive histopathologic diagnosis. Overall sensitivity was 68.36%; specificity was 78.15%; positive predictive value (PPV) was 49.72%; and negative predictive value was 88.66%. All lesions had high specificity (powder-burn, 96.20%; white scarring, 91.34%; clear vesicles; 92.54%; red-flame, 97.84%; and peritoneal pockets; 95.91%). PPV depended on lesion type (powder-burn, 65.75%; white scarring, 51.61 %; clear vesicles, 45.74%; red-flame, 39.13% peritoneal pockets, 28.95%). Conclusions: Visual detection of endometriosis during surgical evaluation is not reliable. The potential for atypical-lesion appearance and disease not macroscopically visible suggests a role for complete pelvic peritonectomy. (J GYNECOL SURG 39:235)