AAGL 2012: Endometriosis May Be Underdiagnosed

A study to determine the prevalence rate of endometriosis in Hispanic women undergoing laparoscopy for gynecologic disorders found that endometriosis may be under diagnosed due to failure to biopsy suspected lesions at the time of surgery and failure to accurately dictate and thoroughly describe operative findings in OpNote.

The study, “Prevalence of Endometriosis in Hispanic Women Undergoing Gynecologic Laparoscopy at LAC+USC Medical Center” presented by Claire Templeman, MD, included 269 patients. Patients were Hispanic, between 18 and 50 years old and were not pregnant.

Of the 269 patients, 90 were enrolled in a video-reporting of the diagnostic portion of their laparoscopy. Videos were later reviewed by a senior laparoscopist with extensive experience in endometriosis. OpNote recordings were also reviewed for any mention of endometriosis during surgery.

“Most commonly,” Templeman said, “endometriosis was found in our video group when the video recordings were reviewed by a senior laparoscopist. In fact, [about] 50% of all [patients] had endometriosis. On the other hand, only 12% on the non-video group and 19% of all subjects in both groups had endometriosis [documented] on OpNote together with histopathologic confirmation.”

In the video group, prevalence of endometriosis was 42.4% (n=38); of these patients 42.1% had Stage 1 endometriosis. In 26 cases, endometriosis was prevalent on the operative report as well as the video, and was supported by histopathologic confirmation.  A sample of suspicious endometriotic lesions occurred in six of the eight patients who did not have histopathologic confirmation. Thirty-five of the ninety women in the study had endometriosis as indicated in operative notes.

While data reporting the prevalence of endometriosis in Hispanic populations is scarce, the study found similar rates of endometriosis to other ethnicities, between 28.9% and 42.2%. “The take-home points are to have a thorough surgical abdominal pelvic evaluation,” Templeman said, “biopsy of suspected lesions at the time of surgery, and comprehensive dictation of operative findings.”