Marchino Gian Luigi, Gennarelli Gianluca, Enria Raffaella, Bongioanni Francesca, Lipari Giovanni, Massobrio Marco
Department of Obstetrics and Gynecology, S. Anna Hospital, University of Torino, Turin, Italy.
Fertil Steril. 2005 Jul;84(1):12-5. doi: 10.1016/j.fertnstert.2004.09.042.
To obtain histologic confirmation of lesions suspected of endometriosis at laparoscopy.
Prospective clinical study.
Patients in an academic hospital.
PATIENT(S): Women of reproductive age who complained of chronic pelvic pain.
INTERVENTION(S): A total of 122 biopsies were obtained from 54 patients undergoing laparoscopy, after exclusion of other potential causes of pelvic pain.
MAIN OUTCOME MEASURE(S): Lack of consistency between laparoscopic and histologic diagnosis of endometriosis, in particular for minimal/mild stages.
Endometriosis was confirmed by histology in 54% of the excised lesions. Diagnosis was more often confirmed among classic lesions than for all atypical lesions considered together. The histologic diagnosis of fibrosis was the most common among those biopsies, which lacked the presence of endometriosis. The revised American Fertility Association (AFS) scores before and after histologic confirmation differed significantly. In particular, 20 patients in either revised AFS class I or II were down-graded to stage 0. No single anatomical site turned out to be particularly prone to misdiagnosis at laparoscopy, in comparison to the other sites.
CONCLUSION(S): These results confirm the need of histologic confirmation to obtain a diagnosis of endometriosis. However, the clinical impact of such findings remains a matter of debate.
在腹腔镜检查时获取疑似子宫内膜异位症病变的组织学确诊。
前瞻性临床研究。
一家学术医院的患者。
主诉慢性盆腔疼痛的育龄女性。
在排除盆腔疼痛的其他潜在病因后，对54例接受腹腔镜检查的患者共获取了122份活检样本。
子宫内膜异位症腹腔镜诊断与组织学诊断之间缺乏一致性，尤其是对于微小/轻度分期。
54%的切除病变经组织学确诊为子宫内膜异位症。经典病变的诊断比所有非典型病变综合起来更常得到确诊。在那些缺乏子宫内膜异位症的活检样本中，纤维化的组织学诊断最为常见。组织学确诊前后修订的美国生育协会（AFS）评分有显著差异。特别是，20例处于修订AFS I级或II级的患者被降级为0期。与其他部位相比，没有单一解剖部位在腹腔镜检查时特别容易误诊。
这些结果证实了需要组织学确诊来诊断子宫内膜异位症。然而，这些发现的临床影响仍存在争议。
