Association Between Laparoscopic Appearance of Superficial Endometriosis, Positive Histology, and Systemic Hormone Use

Study Objective: To assess the association between laparoscopic appearance of superficial endometriosis lesions, histopathology, and systemic hormone use. Design: Retrospective study. Setting: Tertiary care academic medical center. Patients: We identified 266 women who underwent laparoscopic surgery at an endometriosis center with excision of lesions consistent with possible superficial endometriosis between September 2015 and November 2018. Interventions: Appearance of the peritoneal lesions was confirmed with review of surgical videos and correlated with each pathology specimen. Lesions were dichotomized on positive or negative pathology assessment. All pathology-positive lesions were further dichotomized by hormone use within 1 month of surgery. Measurements and Main Results: A total of 841 lesions were biopsied from included subjects during the study period. Of those, 251 biopsies were negative, and 590 were positive for endometriosis on pathology assessment. Lesions had significantly higher odds of positive histology when they were red (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.17–2.48), white (OR, 1.99; 95% CI, 1.47–2.70), blue/black (OR, 2.98; 95% CI, 2.00–4.44), or puckering (OR, 9.78; 95% CI, 2.46–38.91) in appearance. The following combined characteristics had significantly higher odds of positive histology: white and blue (OR, 5.98; 95% CI, 2.97–12.02), red and white (OR, 2.22; 95% CI, 1.38–3.56), red and blue (OR, 4.11; 95% CI, 1.83–9.24), and clear and white (OR, 8.77; 95% CI, 1.17–66.02). Among positive biopsies, those with hormone exposure were more likely to have clear lesions than those without hormone use (OR, 3.36; 95% CI, 1.54–7.34) and were 2.89 times more likely to have clear and white lesions (95% CI, 1.07–7.85). Conclusion: Although lesions suspicious for endometriosis may have differing rates of positive pathology based on appearance, no lesion characteristic was able to exclude the possibility of endometriosis. In addition, hormone use may influence lesion appearance at the time of surgery, with clear lesions more prevalent. These data have implications for appropriate identification of endometriosis at the time of laparoscopy to ensure accurate diagnosis and complete treatment of disease.