Elsevier

Journal of Minimally Invasive Gynecology

Volume 15, Issue 5, September–October 2008, Pages 538-540
Journal of Minimally Invasive Gynecology

Original Article
Endometriomas as a Marker of Disease Severity

https://doi.org/10.1016/j.jmig.2008.05.004Get rights and content

Abstract

Study Objective

Although superficial endometriosis can be treated effectively and safely by most gynecologic surgeons, deep infiltrating disease (DIE) needs to be treated in specialist endometriosis centers. For women to be treated in the most appropriate setting, it is necessary to identify if they have DIE.

Design

Prospective observational study (Canadian Task Force classification II-2).

Setting

Dedicated pelvic pain clinic attracting both secondary and tertiary referrals.

Patients

A total of 295 women with histologically confirmed endometriosis.

Interventions

Prospective intraoperative data were collected to investigate the role of endometriomas as a marker for DIE, and in particular, rectosigmoid disease.

Measurements and Main Results

In all, 61 (21%) women had an endometrioma. A significantly greater proportion of women with an endometrioma had accompanying endometriotic disease affecting the bowel compared with women without an endometrioma (77% vs 21%; p <.001). A strong relationship existed between presence of endometrioma and posterior cul-de-sac obliteration, rectosigmoid disease, and involvement of the seromuscular layer of the bowel. The presence of an endometrioma significantly increased the probability of having rectosigmoid disease, with a positive likelihood ratio of 6.96 (95% CI; 4.04–12.00). However, the absence of an endometrioma did not preclude having rectosigmoid disease, with a negative likelihood ratio of 0.55 (95% CI; 0.45–0.67).

Conclusion

Although endometriomas provide a useful marker for DIE, the absence of an endometrioma does not preclude the presence of DIE, although a significantly lower proportion of women without an endometrioma will have DIE when compared with women with an endometrioma.

Section snippets

Methods

Local ethical and research governance approval was sought and granted before the study.

A prospective observational study was carried out from January 2003 through August 2005. Women were recruited from a single dedicated pelvic pain clinic in a United Kingdom National Health Service trust, attracting both secondary and tertiary referrals. All women requiring a laparoscopy for investigation and treatment of their chronic pelvic pain with histologically proved endometriosis were included in the

Results

During the 32-month period of the study, 295 women were identified as having endometriosis and underwent laparoscopic excision of all identifiable endometriotic deposits.

The median age was 31 years (interquartile range 26–36 years). Severity of disease was assessed by the r-ASRM score, and 31% of women had stage 1 disease, 24% stage 2, 13% stage 3, and 32% stage 4. In all, 61 (21%) women had an endometrioma, which was confirmed histologically in all cases. The endometrioma was found on the left

Discussion

r-ASRM scores are reported, but as they are heavily dependant on the presence or absence of endometrioma, these scores are not considered further other than to show the broad spectrum of disease in this cohort, with around a third of the sample having severe disease.

The moderately high positive likelihood ratios reported in this study shows that in this cohort of women with endometriosis, the presence of endometrioma is a good indicator of rectosigmoid disease involvement and posterior

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The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

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