The measurement of surface area of endometriotic implants by morphometric analysis

There are numerous staging methods for the assessment and evaluation of endometriosis both before and after treatment. Present systems rely on subjective criteria that are prone to bias and error. This report describes an objective technique for the measurement of surface area of pelvic endometriotic implants that is both accurate and reproducible. Six patients with endometriosis underwent laparoscopy and were staged using the Revised American Fertility Society criteria; the lesions were photographed simultaneously. These patients were then treated with either danazol or Nafarelin acetate for 6 months before a second-look laparoscopy. Using coded photographic slides, implants were measured using computerized morphometric analysis. An accurate record of the number and surface area of the lesions was obtained before and after treatment. The mean surface area of individual lesions and the total visible disease per patient fell by 89 and 82%, respectively. The mean number of lesions per patient actually rose by 30% as a result of fragmentation into smaller plaques. These data suggest that morphometry may be more valuable in the assessment of endometriotic implants than are all previously described staging systems.