Sara-Michelle Gratton1, Abdul Jamil Choudhry2, George A Vilos3, Angelos Vilos4, Kristina Baier5, Simonne Holubeshen6, Maria Cassandra Medor7, Stéphanie Mercier8, Vincent Nguyen9, Innie Chen10. 1. Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, London, ON. Electronic address: sgratton@uwo.ca. 2. Ottawa Hospital Research Institute, Ottawa, ON. 3. Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, London, ON; Minimally Invasive Gynecology, The Fertility Clinic, London Health Science Center-Victoria Hospital, London, ON. 4. Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, London, ON; The Fertility Clinic, London Health Science Center-Victoria Hospital, London, ON. 5. Department of Family Medicine, University of Ottawa, Ottawa, ON. 6. Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON. 7. Département de Chirurgie, Division de Chirurgie plastique, Université de Montréal, Montréal, QC. 8. Department of Medicine, Division of Internal Medicine, University of Ottawa, Ottawa, ON. 9. Division of Obstetrics & Gynecology, University of Ottawa, Ottawa, ON. 10. Ottawa Hospital Research Institute, Ottawa, ON; Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, ON; Minimally Invasive Gynecology, The Ottawa Hospital, Ottawa, ON.
Abstract
OBJECTIVE: This study aimed to evaluate the validity of laparoscopic visualization for the diagnosis of endometriosis compared with histopathology. METHODS: We conducted a retrospective chart review at a tertiary care hospital in Canada for the period of April 1, 2016 to March 31, 2017. Of 1069 women, 96 were selected for having undergone laparoscopic visualization and concurrent histopathological biopsy for suspected endometriosis. Standard measures of validity for diagnostic tests (sensitivity, specificity, positive predictive and negative predictive values, accuracy) were used. RESULTS: Mean age of the 96 women included was 40 ± 7.2 years, and median gravidity and parity were 1 (IQR 0-3) and 0 (IQR 0-2), respectively. Common symptoms were abdominal and pelvic pain (41.7%), menstrual bleeding concerns (34.4%), dysmenorrhea (29.2%), and infertility (8.3%). Approximately one-third of women had endometriomas (31.3%), while more than half had deep infiltrating endometriosis (59.4%). The diagnosis of endometriosis was made by surgeons at laparoscopic visualization in 82.3% of women and by histopathology in 74.0%. Using histopathology as the gold standard, sensitivity for laparoscopic visualization was 90.1% (95% CI 81.0-95.1), while specificity was 40.0% (95% CI 23.4-59.3). Positive and negative predictive values were 81.0% (95% CI 71.0-88.1) and 58.8% (95% CI 36.0-78.4), respectively; and the accuracy was 77.1% (95% CI 67.7-84.4). CONCLUSION: Although laparoscopic visualization had relatively high sensitivity and positive predictive value, its specificity and negative predictive value were relatively low. These findings support the use of laparoscopic visualization with histopathological analysis for accurate diagnosis of endometriosis.
OBJECTIVE: This study aimed to evaluate the validity of laparoscopic visualization for the diagnosis of endometriosis compared with histopathology. METHODS: We conducted a retrospective chart review at a tertiary care hospital in Canada for the period of April 1, 2016 to March 31, 2017. Of 1069 women, 96 were selected for having undergone laparoscopic visualization and concurrent histopathological biopsy for suspected endometriosis. Standard measures of validity for diagnostic tests (sensitivity, specificity, positive predictive and negative predictive values, accuracy) were used. RESULTS: Mean age of the 96 women included was 40 ± 7.2 years, and median gravidity and parity were 1 (IQR 0-3) and 0 (IQR 0-2), respectively. Common symptoms were abdominal and pelvic pain (41.7%), menstrual bleeding concerns (34.4%), dysmenorrhea (29.2%), and infertility (8.3%). Approximately one-third of women had endometriomas (31.3%), while more than half had deep infiltrating endometriosis (59.4%). The diagnosis of endometriosis was made by surgeons at laparoscopic visualization in 82.3% of women and by histopathology in 74.0%. Using histopathology as the gold standard, sensitivity for laparoscopic visualization was 90.1% (95% CI 81.0-95.1), while specificity was 40.0% (95% CI 23.4-59.3). Positive and negative predictive values were 81.0% (95% CI 71.0-88.1) and 58.8% (95% CI 36.0-78.4), respectively; and the accuracy was 77.1% (95% CI 67.7-84.4). CONCLUSION: Although laparoscopic visualization had relatively high sensitivity and positive predictive value, its specificity and negative predictive value were relatively low. These findings support the use of laparoscopic visualization with histopathological analysis for accurate diagnosis of endometriosis.