Using location, color, size, and depth to characterize and identify endometriosis lesions in a cohort of 133 women

Objective To correlate histology with endometriosis characteristics. Design Secondary data analysis. Setting Government research hospital. Patient(s) One hundred thirty-three women with chronic pelvic pain and endometriosis who underwent laparoscopic surgery between 1999 and 2004. Intervention(s) Laparoscopic excision of lesions, including recording of lesion characteristics and surgical impression of the lesions. Main Outcome Measure(s) All biopsies were sent for histological examination for endometriosis, and surgical and histological findings were compared. Result(s) Three hundred fifty-seven of 544 lesions believed to be endometriosis by the surgeon had positive histology. Mixed-color lesions most commonly contained endometriosis (76%), with the percentage of positive lesions being similar between single-color groups. Among subtle (red or white) lesions, 58% (164/283) were positive for endometriosis. Thirty women had only red or white lesions, and 18 (60%) had at least one lesion positive for endometriosis. Lesions were most commonly located in the cul-de-sac (64%), utero-sacral ligaments (68%), and ovarian fossa (70%). Conclusion(s) Wide, deep, mixed-color lesions in the cul-de-sac, the ovarian fossa, or the utero-sacral ligaments had the highest frequency of endometriosis. More than half of subtle lesions had endometriosis. These results should be considered when diagnosing endometriosis.