Correlation of Endometriosis on MRI and Surgical Pathology

Location

Medical Education Building, LSUHSC-NO

Presentation Date

10-10-2019 10:00 AM

End Date

10-10-2019 12:00 PM

Description

ABSTRACT Study Objective: The aim of this study is to assess whether the use of MRI as part of preoperative workup in the setting of patients with chronic pelvic pain and presumed diagnosis of endometriosis is predictive of pathology-proven endometriosis. Additionally, this study aims to deduce the efficacy of MRI in identifying endometriosis in asymptomatic patients. Design: All surgical cases performed by a single fellowship trained minimally invasive gynecologist at two tertiary hospitals in New Orleans between November 2017 and February 2019 were reviewed and laparoscopic cases were identified, totaling 68 cases. Laparoscopic cases in which a preoperative MRI was performed were then identified. These cases were reviewed to assess for presence or absence of: (1) a preoperative prediction of endometriosis, (2) identification of endometriosis on preoperative MRI, and (3) surgical diagnosis of endometriosis based on intraoperative findings or surgical pathology. A literature review was performed to assess sensitivity and specificity of ultrasound (US) in identification of endometriosis. A Bayesian hierarchical meta-analysis was performed to borrow strength from these US-based sensitivities and specificities and to compare these proportions statistically. Setting: Retrospective chart review Patients or Participants: Chart review for 68 patients operated on by one fellowship trained minimally invasive gynecologist over 16 months. Interventions: Laparoscopy Measurements and Main Results: The posterior probability that the MRI sensitivity was the highest compared to the 5 US studies from our literature review was .043. The posterior probability that the MRI had the highest specificity compared to the US studies was .370. These results suggest that MRI provides comparable sensitivity and specificity to several ultrasound studies, which warrants a larger study including diagnostic potential of combined ultrasound and MRI. Conclusion: Our study showed that preoperative MRI is comparable to ultrasound in both sensitivity and specificity of endometriosis diagnosis. Ultrasound is the initial and, oftentimes, the only form of imaging done in the setting of suspected endometriosis. Preoperative MRI may be used as part of the workup of patients with presumed endometriosis because it allows for evaluation of all pelvic compartments as well as insight into the severity and extent of filtration of endometriosis lesions. This allows for identification of complex endometriosis cases which would necessitate further surgical planning and would warrant referral to an advanced surgeon or an endometriosis specialist. MRI is also less susceptible to intra- and interobserver variability compared to US imaging. Combination of MRI and transvaginal ultrasound within the preoperative workup of suspected endometriosis cases may therefore increase diagnostic accuracy even further.

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Mentor: Stacey A. Scheib, MD

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Oct 10th, 10:00 AM Oct 10th, 12:00 PM

Correlation of Endometriosis on MRI and Surgical Pathology

Medical Education Building, LSUHSC-NO

ABSTRACT Study Objective: The aim of this study is to assess whether the use of MRI as part of preoperative workup in the setting of patients with chronic pelvic pain and presumed diagnosis of endometriosis is predictive of pathology-proven endometriosis. Additionally, this study aims to deduce the efficacy of MRI in identifying endometriosis in asymptomatic patients. Design: All surgical cases performed by a single fellowship trained minimally invasive gynecologist at two tertiary hospitals in New Orleans between November 2017 and February 2019 were reviewed and laparoscopic cases were identified, totaling 68 cases. Laparoscopic cases in which a preoperative MRI was performed were then identified. These cases were reviewed to assess for presence or absence of: (1) a preoperative prediction of endometriosis, (2) identification of endometriosis on preoperative MRI, and (3) surgical diagnosis of endometriosis based on intraoperative findings or surgical pathology. A literature review was performed to assess sensitivity and specificity of ultrasound (US) in identification of endometriosis. A Bayesian hierarchical meta-analysis was performed to borrow strength from these US-based sensitivities and specificities and to compare these proportions statistically. Setting: Retrospective chart review Patients or Participants: Chart review for 68 patients operated on by one fellowship trained minimally invasive gynecologist over 16 months. Interventions: Laparoscopy Measurements and Main Results: The posterior probability that the MRI sensitivity was the highest compared to the 5 US studies from our literature review was .043. The posterior probability that the MRI had the highest specificity compared to the US studies was .370. These results suggest that MRI provides comparable sensitivity and specificity to several ultrasound studies, which warrants a larger study including diagnostic potential of combined ultrasound and MRI. Conclusion: Our study showed that preoperative MRI is comparable to ultrasound in both sensitivity and specificity of endometriosis diagnosis. Ultrasound is the initial and, oftentimes, the only form of imaging done in the setting of suspected endometriosis. Preoperative MRI may be used as part of the workup of patients with presumed endometriosis because it allows for evaluation of all pelvic compartments as well as insight into the severity and extent of filtration of endometriosis lesions. This allows for identification of complex endometriosis cases which would necessitate further surgical planning and would warrant referral to an advanced surgeon or an endometriosis specialist. MRI is also less susceptible to intra- and interobserver variability compared to US imaging. Combination of MRI and transvaginal ultrasound within the preoperative workup of suspected endometriosis cases may therefore increase diagnostic accuracy even further.