Accuracy of laparoscopy for assessing patients with endometriosis
Keywords:
Endometriosis, Pelvic pain, Laparoscopy, Infertility, HistologyAbstract
CONTEXT AND OBJECTIVE: Diagnoses of endometriosis are based on observation of endometriotic lesions by means of laparoscopy, along with the pathological fi ndings. The aim of this study was to evaluate the sensitivity and specifi city of the macroscopic fi ndings in relation to the histopathological fi ndings. More specifi cally, we aimed to test the effi cacy of laparoscopy alone for diagnosing endometriosis and to evaluate the laterality of endometriosis among the study population. DESIGN AND SETTING: Cross-sectional study on women undergoing laparoscopy due to pelvic pain or infertility, in the Gynecology Department of Hospital Santa Cruz in Curitiba, Paraná, Brazil, and Pontifícia Universidade Católica do Paraná. METHODS: A total of 976 patients underwent laparoscopy and biopsy due to pelvic pain and/ or infertility. We analyzed the laparoscopic and histopathological fi ndings from patients with pelvic endometriosis (n = 468) and patients without endometriosis (n = 508). RESULTS: In 468 (47.95%) of the cases, the clinical and laparoscopic fi ndings were consistent with endometriosis, and this was confi rmed histopathologically in 337 (34.5%). Among the remaining 508 patients, although the laparoscopy was performed for other reasons relating to acute pelvic pain, eight were diagnosed with endometriosis from histopathological examination of the pelvic specimens obtained. Therefore, endometriosis was confi rmed in 345 patients (35.3%). In comparison with the histopathology, laparoscopy alone presented 97.68% sensitivity, 79.23% specifi city, 72% positive predictive value and 98.42% negative predictive value.
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References
Jansen RP, Russell P. Nonpigmented endometriosis: clinical, laparoscopic, and pathologic definition. Am J Obstet Gynecol. 1986;155(6):1154-9.
Olive DL, Henderson DY. Endometriosis and mullerian anomalies. Obstet Gynecol. 1987;69(3 Pt 1):412-5.
Matorras R, Rodriguez F, Pijoan JI, et al. Are there any clinical signs and symptoms that are related to endometriosis in infertil- ity women? Am J Obstet Gynecol. 1996;174(2):620-3.
Houston DE. Evidence for the risk of pelvic endometriosis by age, race and socioeconomic status. Epidemiol Rev. 1984;6:167- 91.
Redwine DB. Age-related evolution in color appearance of endometriosis. Fertil Steril. 1987;48(6):1062-3.
Abrão MS, Neme RM, Averbach M. Endometriose de septo retovaginal: doença de diagnóstico e tratamento específicos. [Rectovaginal septum endometriosis: a disease with specific diag- nosis and treatment]. Arq Gastroenterol. 2003;40(3):192-7.
Tardif D, Poncelet C, Bénifla JL, Madelenat P. Exploration paraclinique des endométrioses. [Paraclinical studies of endo- metriosis] Rev Prat. 1999;49(3):263-8.
Vercellini P, Trespidi L, De Giorgi O, Cortesi I, Parazzini F, Cro- signani PG. Endometriosis and pelvic pain: relation to disease stage and localization. Fertil Steril. 1996;65(2):299-304.
Wykes CB, Clark TJ, Khan KS. Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic quantitative review. BJOG. 2004;111(11):1204-12.
Kennedy S, Bergqvist A, Chapron C, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698-704.
Revised American Fertility Society classification of endometrio- sis: 1985. Fertil Steril. 1985;43(3):351-2.
Weiner Z, Beck D, Brandes JM. Transvaginal sonography, color flow imaging, computed tomographic scanning, and CA 125 as a routine follow-up examination in women with pelvic tumor: detection of recurrent disease. J Ultrasound Med. 1994;13(1):37-41.
Amaral VF, Ferriani RA, Sá MF, et al. Positive correlation be- tween serum and peritoneal fluid CA-125 levels in women with pelvic endometriosis. Sao Paulo Med J. 2006;124(4):223-7.
Stratton P, Winkel C, Premkumar A, et al. Diagnostic accuracy of laparoscopy, magnetic resonance imaging, and histopathologic examination for the detection of endometriosis. Fertil Steril. 2003;79(5):1078-85.
Walter AJ, Hentz JG, Magtibay PM, Cornella JL, Magrina JF. Endometriosis: correlation between histologic and visual find- ings at laparoscopy. Am J Obstet Gynecol. 2001;184(7):1407- 11; discussion 1411-3.
Kresch AJ, Seifer DB, Sachs BL, Barrese I. Laparoscopy in 100 women with chronic pelvic pain. Obstet Gynecol. 1984;64(5):672-4.
Zondervan KT, Cardon LR, Kennedy SH. The genetic basis of endometriosis. Curr Opin Obstet Gynecol. 2001;13(3):309- 14.
Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL. Time elapsed from onset of symptoms to diagnosis of endo- metriosis in a cohort study of Brazilian women. Hum Reprod. 2003;18(4):756-9.
Petta CA, Paiva LHSC, Pinto Neto AM, Fonseca E, Lane E. O uso da laparoscopia na dor pélvica crônica. [The use of lap- aroscopy in women with pelvic chronic pain]. J Bras Ginecol. 1990;100(3/4):85-7.
Gruppo Italiano per lo Studio dell’Endometriosi. Relationship between stage, site and morphological characteristics of pelvic endometriosis and pain. Hum Reprod. 2001;16(12):2668-71.
Bai SW, Cho HJ, Kim JY, et al. Endometriosis in an adolecent population: the severance hospital in Korean experience. Yonsei Med J. 2002;43(1):48-52.
Chapron C, Fauconnier A, Dubuisson JB, Barakat H, Vieira M, Bréart G. Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease. Hum Reprod. 2003;18(4):760-6.
Abrão MS, Amaral VF, Ramos LO. Classificações da endometri- ose: é tempo de reavaliar. [Classification of endometriosis: is time to re-evaluate]. Femina. 1998;26(8):677-80.
Wardle PG, Hull MG. Is endometriosis a disease? Baillieres Clin Obstet Gynaecol. 1993;7(4):673-85.
Fedele L, Bianchi S, Bocciolone L, Di Nola G, Parazzini F. Pain symptoms associated with endometriosis. Obstet Gynecol. 1992;79(5 (Pt 1)):767-9.
Abrao MS, Neme RM, Carvalho FM, Aldrighi JM, Pinotti JA. Histological classification of endometriosis as a predictor of re- sponse to treatment. Int J Gynaecol Obstet. 2003;82(1):31-40.
Topalski Fistes N, Maticki Sekuli M, Kopitovi V, Tabs D. Endometrioza i bol. [Endometriosis and pain]. Med Pregl. 2002;55(9-10):415-8.
Sznurkowski J, Emerich J. Czestsza lewostronna lokalizacja torbieli endometrialnych. [Left lateral predisposition of endo- metrioma]. Ginekol Pol. 2005;76(1):33-6.
Ferrero S, Ragni N, Fulcheri E. Lateral distribution of benign ovarian cysts. Int J Gynaecol Obstet. 2005;89(2):150-1.
