Improving Diagnostic Yield in Peritoneal Endometriosis: Value of Additional Level Sections and Sampling Protocols
Veronica Alvarez1, Emily Parent2, Jonathan L Hecht1
1Department of Pathology, Beth Israel Deaconess Medical Center.
Summary
Submitting more tissue blocks per site and using deeper histologic sections significantly improve the diagnosis of endometriosis in peritoneal biopsies. Surgeon expertise and sampling more sites also enhance diagnostic yield.
Area of Science:
- Gynecology
- Surgical Pathology
Background:
- Endometriosis diagnosis relies on accurate histologic confirmation from peritoneal biopsies.
- Optimizing tissue processing and sampling techniques is crucial for improving diagnostic yield.
Purpose of the Study:
- To assess if deeper histologic sections and increased tissue-blocking improve endometriosis detection in peritoneal biopsies.
- To evaluate the impact of surgical approach and pathologist expertise on diagnostic accuracy.
Main Methods:
- Retrospective review of 148 peritoneal biopsy cases with suspected endometriosis.
- Analysis of diagnostic yield based on the number of tissue blocks per site and use of additional histologic levels.
- Assessment of associations with surgical approach, number of biopsy sites, and pathologist variability.
Main Results:
- Endometriosis detection increased with more tissue blocks per site (86% with ≥3 blocks vs. 60% with 1 block).
- Additional histologic levels improved detection in initially negative cases (P=0.039).
- Higher diagnostic yields were associated with subspecialty-trained surgeons and more biopsy sites sampled (P=0.0009).
Conclusions:
- Increased tissue blocks per site, deeper histologic sections, and broader surgical sampling enhance the diagnosis of peritoneal endometriosis.
- Variability in diagnostic yield among surgeons and pathologists highlights the need for standardized protocols.
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