Association between pathological positivity rate of endometriosis, demographics, and concomitant gynecological conditions

Daniela Moiño; Papri Sarkar; Maha Al Jumaily; Samantha Malak; Jean Paul Tanner; Emad Mikhail

doi:10.1177/26334941241242351

Association between pathological positivity rate of endometriosis, demographics, and concomitant gynecological conditions

Ther Adv Reprod Health. 2024 Apr 13:18:26334941241242351. doi: 10.1177/26334941241242351. eCollection 2024 Jan-Dec.

Authors

Daniela Moiño¹, Papri Sarkar², Maha Al Jumaily², Samantha Malak³, Jean Paul Tanner⁴, Emad Mikhail⁵

Affiliations

¹ University of South Florida Morsani College of Medicine, Tampa, FL, USA.
² Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA.
³ University of South Florida, Tampa, FL, USA.
⁴ College of Public Health, University of South Florida, Tampa, FL, USA.
⁵ Division of Gynecologic Subspecialities, Department of Obstetrics and Gynecology, University of South Florida, 2 Tampa General Circle, STC, 6th Floor, Tampa, FL 33606, USA.

Abstract

Background: To date, there remains a paucity of present-day literature on the topic of demographics and the biopsy-proven pathological positivity rate of endometriosis.

Objective: The goal of this study was to explore the association between patients' demographics and other concomitant gynecological conditions or procedures and the pathological positivity rate of excision of endometriosis.

Design: Retrospective cohort study.

Methods: All women >18 years old who underwent laparoscopic surgery for endometriosis at a tertiary care hospital from October 2011 to October 2020. Women were classified into two groups: (1) Study group: women with >80% pathological positivity rate of endometriosis and (2) Control group: women with <80% pathological positivity rate.

Results: A total of 401 women were included in the analysis. No difference was noted in the 80% pathological positivity rate based on body mass index [BMI; 68.7% in normal BMI versus 80% in underweight, versus 74.5% in overweight, and 74.1% in obese patients (p = 0.72)]. The percentage of patients reaching 80% pathological positivity of endometriosis was lower in women who had undergone previous laparoscopy for endometriosis compared to surgery naïve women (66.5% versus 76.5%, p = 0.03). In addition, a higher percentage of women who underwent concomitant hysterectomy (83.5% versus 68.8% for non-hysterectomy, p = 0.005) or bilateral oophorectomy (92.7% versus 70.0% for non-oophorectomy, p = 0.002) reached 80% pathological positivity. Women with an associated diagnosis of fibroids (79.7% versus 70.5%) or adenomyosis (76.4% versus 71.7%) were more likely to reach 80% pathological positivity compared to women without any other coexisting pathology; however, the observed differences were not statistically significant. After applying a log-binomial regression model, compared to White non-Hispanics, Hispanic patients were 30% less likely to reach 80% positivity (RR: 0.70, 95% CI: 0.49-1.02), although not statistically significant.

Conclusion: No significant racial difference was found when comparing the rates of 80% pathological positivity of suspected endometriosis lesions among groups. Endometriosis pathological positivity rate was unaffected by patients' BMI and the presence of concomitant pathologies. In addition, prior laparoscopic surgery for endometriosis might cause tissue changes that result in a decrease in the observed pathological positivity rate of endometriosis lesions during subsequent surgeries.

Keywords: BMI; minimally invasive surgeon; pathologically-proven endometriosis; race; surgical History.