Characteristics of Suspected Endometriosis without Histologic Confirmation

STUDY OBJECTIVE: We aim to describe the clinical and laparoscopic features of suspected endometriosis lacking histologic confirmation. DESIGN: Retrospective cohort study. SETTING: Quaternary community medical center. PATIENTS OR PARTICIPANTS: All consecutive pathology reports from patients who underwent surgery for clinically suspected endometriosis by three surgeons from the Division of Minimally Invasive Gynecologic Surgery between 01/01/2016 and 12/31/2019 were reviewed and categorized in two groups: endometriosis histologically confirmed, and endometriosis not histologically confirmed. A retrospective analysis of the patients without confirmed endometriosis was performed by evaluating clinical, surgical, and histologic characteristics. INTERVENTIONS: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Of 487 patients, endometriosis was histologically confirmed in 419 (86.0%) and not confirmed in 68 (14.0%). Study group age range was 16 to 48 (median 30.5). Patients clinically presented with a variety of symptoms suspicious for endometriosis. 23 (33.8%) of the 68 patients without confirmed endometriosis had other gynecologic abnormalities, including leiomyomata, endometrial polyps or adenomyosis. 39 cases (57.3%) without confirmed endometriosis had non-specific histopathologic findings such chronic inflammation, fibrosis, adhesions, reactive changes, and hemosiderin deposits, while the remaining 29 (42.6%) had no histologic abnormalities. On laparoscopic evaluation, lesions appeared heterogeneous and suspicion of endometriosis was high in 10 (15%), low in 36 (53%), and absent in 22 (32%) patients. Laparoscopically, there were 14 cases without any abnormality visualized in the group with no histologic abnormalities (48%) compared to only 5 cases in the group with histologic findings (13%). CONCLUSION: Despite the absence of histologically confirmed endometriosis, patients with clinically suspected disease still experience significant symptoms and management decisions remain challenging for both patientsand clinicians. Over half of the patients without confirmed endometriosis had non-specific histopathologic findings. Further research should analyze how these findings correlate to the clinical symptoms of patients with suspected endometriosis and role in management in such patients.