Diagnostic Accuracy of laparoscopic Visual Inspection of Pelvic Endometriosis

Abstract

The present study was designed to assess accuracy of visual diagnosis of laparoscopically excised visceral and peritoneal abnormalities suggestive of endometriosis in comparison to histopathological diagnosis. This study was carried out at laparoscopy unit at Ain Shams Maternity Hospital in the period starting from January 2015 to January 2016 on 50 patients with ages ranging from 18-40 years. All women underwent laparoscopy through which seven sites were visualized for endometriosis (uterus, right& left ovaries, right & left ovarian fossae, douglas pouch and peritoneum). Pelvic pain was the most frequent clinical presentation with a percentage of 68%, endometriosis was found in about three quarters of cases of suspected cases. Grade one was the most frequent grade 33.3% followed by grade four 26.2%, grade three 23.8% and grade two 16.7%. Uterus was the least frequent site represented 8% among studied cases when studying endometriosis by laparoscopy and histopathology.

There was significant moderate agreement between laparoscopy visualization and histopathology in diagnosis of endometriosis in uterus; significant weak agreement in right ovary; significant moderate agreement in left ovary, right ovarian fossa, left ovarian fossa, douglas pouch and peritoneum. Uterus was the most accurate site diagnosed by laparoscopy (96%), followed by right ovary, left ovary, right ovarian fossa with percentage (92%) each, Douglas pouch and peritoneum (88%) each and left ovarian fossa (86%). This study also revealed the histopathology findings of false-suspected endometriosis by laparoscopy. Laparoscopy, particularly a first procedure, serves both a diagnostic and therapeutic purpose. The initial step is exploration of the pelvis and abdomen. Diagnosis of endometriosis by visual inspection of lesions at laparoscopy is considered satisfactory.