- Email: [email protected]
Hospital-Related Costs for Endometriosis in Canada
S36
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44
Measurements and Main Results: Tumoral markers levels were measured in blood samples obtained in the follicular phase of menstrual cycle. In 24 patients with stage I endometriosis (9,8%), according to ASRM classification, CA 125 mean value was 19,42 (IC 95% 14,17-24,67), while CA 19.9 mean value was 18,2 (IC 95% 8,86-27,54). For the 10 patients with stage II endometriosis (4,09%), mean values were respectively 22,5 (IC 95% 10,44-34,56) and 21,63 (IC 95% 11,6442,69). Among 113 patients with stage III endometriosis (46,31%) CA 125 mean value was 55,56 (IC 95% 44,13-66,99), and CA 19.9 46,32 (IC 95% 33,53-59,12); among 97 patients with stage IV of disease (39,75%) mean values were respectively 90,89 (IC 95% 75,10-106,67) and 54,70 (IC 95% 39,19-70,22). A significant positive correlation between the stage of disease and serum markers values was found (p\0,05). In particular, CA 125 mean value gets higher than CA 19.9 for each stage of endometriosis. Conclusion: these results support the hypothesis that both markers analyzed are related to the rAFS score and to the disease stage. The correlation is stronger for CA 125. Further studies are required.
124 Abstract Withdrawn
125
Open Communications 6 - Endometriosis (3:32 PM - 3:37 PM)
Appendiceal Endometriosis: Associations and Risk Factors Moulder JK,1 Jarvis EG,2 Melvin K,1 Hobbs KA,1 Siedhoff MT.1 1 Obstetrics and Gynecology, Division of Advanced Laparoscopy and Pelvic Pain, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; 2Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina Study Objective: Identify incidence of appendiceal pathology and risk factors for appendiceal endometriosis. Design: Retrospective cohort. Setting: University tertiary referral center. Patients: 227 women undergoing gynecological surgery for benign indications in our division between 2010d2013. Intervention: Coincidental appendectomy performed at the time of benign gynecologic surgery. Measurements and Main Results: Demographic, operative and histopathologic data were abstracted from medical records. Univariate and bivariate analyses were performed as appropriate. Logistic regression analysis was performed with pathologic diagnosis of appendiceal endometriosis (AE) as the primary outcome. Mean patient age was 36.8 years (+/- 9.6) and BMI 29.6kg/m2 (+/- 9). Pelvic pain was the most common indication for surgery (47%) and laparoscopic hysterectomy the most common primary procedure (60%). Although most appendices had a normal appearance (60%), 59% of these were assigned a pathologic diagnosis on final examination (including benign variants). 37% of patients had endometriosis diagnosed intraoperatively, and 46% of these women had deep infiltrating endometriosis (DIE). AE was present in 16% of all women with endometriosis, and in 28% of those with DIE. Two patients experienced a minor complication during appendectomy with no significant consequences. On bivariate analysis, AE was associated with nulliparity (p= 0.04), surgical diagnosis of endometriosis or DIE (p=0.001), and abnormal appearance (p=0.02). On regression analysis, patients with DIE had 7.7 times the odds of AE (95%CI: 2.1, 28.9; p=0.003), controlling for race, parity, appendiceal appearance and surgery indication. Conclusion: Coincidental appendectomy is a safe procedure to perform at time of benign gynecological surgery. Coincidental appendectomy as part of definitive treatment for DIE should be considered given the increased odds of AE in these patients.
126
Open Communications 6 - Endometriosis (3:38 PM - 3:43 PM)
What Are We Missing? The Role of Expert Transvaginal Ultrasound in the Diagnosis of Endometriosis Agarwal S,1 Fraser MA,2 Chen I,1 Singh SS.1 1Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, OHRI, Ottawa, Ontario, Canada; 2Department of Medical Imaging, The Ottawa Hospital; University of Ottawa, Ottawa, Ontario, Canada Study Objective: To compare expert guided transvaginal ultrasound (ETVUS) to routine trans vaginal ultrasound (TVUS) for the diagnosis of endometriosis. Design: ERB-approved retrospective chart review of surgically confirmed endometriosis cases undergoing both ETVUS and routine TVUS for the same indication. Setting: Canadian tertiary centre specializing in diagnosis and management of endometriosis. Patients: All cases with surgically confirmed endometriosis and an expert directed endometriosis ultrasound completed at our centre were included for review. Findings from the expert ultrasound were compared to routine pelvic ultrasound performed for the same indication. Measurements and Main Results: 40 cases met inclusion criteria. Mean patient age at first surgical diagnosis was 31 7 years. Dysmenorrhea (77%) and chronic pelvic pain (74%) were the most common presenting symptoms. Sensitivity of routine TVUS was 25% (10/40), compared to 78% (31/40) with ETVUS, (P \0.01). Comparisons were made based on the site and type of lesion. TVUS and ETVUS detected bladder involvement in (0/40) vs. 5% (2/40); ureter (0/40) vs. 8% (3/40); ovary 25% (10/40) vs. 73% (29/40); retrocervical area (0/40) vs. 60% (24/40), rectosigmoid 5% (2/40) vs. 78% (31/40), respectively. Specific endometriotic lesions recognized by TVUS versus ETVUS, were: ovarian endometriomas in 25% (10/40) vs. 45% (18/40), adhesions leading to distorted anatomy in 3% (1/40) vs. 78% (31/40); endometriotic implants or plaques in 3% (1/40) vs. 70% (28/40); and endometriotic nodules in 3% (1/40) vs. 35% (14/40), respectively. Routine TVUS diagnosis relied on the presence or absence of endometrioma (10/10), whereas ETVUS showed additional sites of disease in 97% (30/31) patients. Conclusion: Expert guided transvaginal ultrasound is more sensitive than routine transvaginal ultrasound to diagnose endometriosis, identifying lesions other than endometrioma, and is of assistance in surgical planning and patient counseling. Our future goal is to develop a simplified ETVUS technique for routine use.
127
Open Communications 6 - Endometriosis (3:44 PM - 3:49 PM)
Hospital-Related Costs for Endometriosis in Canada Allaire C,1 MacRae GS,2 Nishi C,2 Chen I.3 1Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; 2Performance Measurement & Reporting, Provincial Health Services Authority, Vancouver, British Columbia, Canada; 3Department of Obstetrics and Gynecology, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Study Objective: To determine the hospital-related costs associated with women requiring surgery or in-patient admission for endometriosis in Canada in recent years. Design: In this population-based cross-sectional study, women who had inpatient admission or surgery for endometriosis were identified using the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD). Surgical interventions were categorized as laparoscopy, adnexal surgery, hysterectomy, or other. Cases were categorised by intervention, age group, and geographical location. Resource intensity weights (RIW) were extracted. Cost per weighted case methodology was used to determine costs. Setting: Hospitals treating women with endometriosis in Canada.
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44 Patients: Women aged 15-59 with a most responsible International Classification of Diseases diagnosis of endometriosis identified using the CIHI-DAD who were discharged from hospital from April 1, 2008 to March 31, 2013. Measurements and Main Results: Over five years , there were 57,879 cases of surgery or in-patient admission with a major diagnosis of endometriosis for a total cost of $186,333,987 (mean $37,266,797/year). The national incidence of hospitalization was 0.7 per 1000 female ageadjusted population and remained stable over the study period . 24,724 (42.7%) of cases were hysterectomies at a cost of $106,310,091; 12,089 (20.9%) were adnexal surgeries costing $42,339,017; 16,524 (28.5%) were laparoscopic procedures costing $25,274,630; 3,392 (5.9%) were admissions for other procedures costing $9,897,474; and 1,150 (2.0%) were admissions with no procedure costing $2,272,514. Incidence of hysterectomy was highest among ages 40-44, while incidence of laparoscopy was highest among ages 30-34. Conclusion: The hospitalization rate for endometriosis remained stable over the study period . The most common reason for admission was hysterectomy. The economic burden of in hospital treatment for endometriosis in Canada is substantial. 128
Open Communications 6 - Endometriosis (3:50 PM - 3:55 PM)
Urine Peptidome for Noninvasive Diagnosis of Endometriosis: A Preliminary Study Liu H, Shi H, Fan Q. Obstetrics & Gynecology, Peking Union Medical College Hospital, Beijing, China Study Objective: To detect endometriosis by urine peptide biomarkers using magnetic beads-based matrix-assisted laser desorption/ionization time-offlight mass spectrometry (MALDI-TOF-MS) and to identify interesting peptides using liquid chromatography tandem mass spectrometry. Design: Prospective case-control study. Setting: University-based gynecological department and central laboratory. Patients: A total of 122 patients suffering from dysmenorrhea, pelvic pain and infertility were enrolled in the study. Intervention: Urine samples were collected before laparoscopy. Urine samples were analyzed by the MALDI-TOF technique to generate peptide profiling and ClinProTools software was used to set up a diagnostic model for endometriosis. Liquid chromatography tandem mass spectrometry (LC–MS/MS) was used to identify interesting peptides. Measurements and Main Results: At laparoscopy 60 patients were diagnosed with endometriosis and 62 patients were disease-free. There were 36 different peptides expressed in endometriosis patients detected by MALDI-TOF compared with controls. We established a genetic algorithm as a diagnostic model with the combination of five peptides (m/z = 1433.9, 1599.4, 2085.6, 6798.0 and 3217.2). The model showed a sensitivity of 90.9% and specificity of 92.9%. Urine from another 26 symptomatic patients before laparoscopy were randomly selected and analyzed accordingly. A genetic algorithm showed a sensitivity of 90.9% and specificity of 92.9% in predicting endometriosis before laparoscopy. We also identified two peptides not belonging to the diagnostic model as collagen precursors. Conclusion: Patients with endometriosis have a unique cluster of peptides in urine. Peptide proteomic profiling provides a novel method for noninvasive diagnosis of endometriosis. 129
Open Communications 6 - Endometriosis (3:56 PM - 4:01 PM)
Repeat Surgery for Endometriosis-Related Pelvic Pain: Pain Scores and Number of Lesions Benjamin AR, Howard FM. Department Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York Study Objective: To evaluate the presence and amount of endometriosis at repeat surgery for persistent or recurrent endometriosis-associated pelvic pain.
S37
Design: A pilot, retrospective study of all patients who underwent repeat surgery for endometriosis-associated pelvic pain. Setting: A university-based chronic pelvic pain clinic. Patients: 59 (24%) of 250 had repeat surgery for endometriosis-associated pelvic pain during the study period. Of these, 32 had intake data that allowed evaluation of measured variables at the time of initial and repeat surgeries. Intervention: All patients had surgical evaluation and treatment for endometriosis-associated pelvic pain. Measurements and Main Results: Average pain levels were not different before the 1st and 2nd surgeries. The average interval between the 1st and 2nd surgery was 19 months, and the mean duration of pain relief after the 1st surgery was 7 months. Postoperative pain relief, defined as at least 30% decrease in pain levels, was 66% with first surgery, compared to 40% with second surgery (odds ratio 2.9, 95% CI 1.0 - 8.0, p = .05). The presence of other co-morbid pain diagnoses did not associate with postoperative pain relief. 81% of patients had fewer endometriosis lesions at 2nd surgery than at 1st surgery. The mean number of endometriosis lesions at 1st surgery was 5.4 3.2 and at the 2nd surgery was 2.4 1.9 (p \ .001). Of the 14 patients who had hysterectomies, 71 % achieved significant pain relief, compared to 19% of those who did not have hysterectomies (p = .004). Conclusion: Although pain levels were the same prior to initial and repeat surgeries, 80% of patients had fewer lesions at repeat surgery. Significant pain relief was less likely after repeat surgery as compared to the initial surgery. Patients who had hysterectomy as part of their surgical treatment were more likely to have pain relief.
130
Open Communications 6 - Endometriosis (4:02 PM - 4:07 PM)
Diagnosis of Deeply Infiltrative Endometriosis: Accuracy of a Specific Magnetic Resonance Imaging Protocol Ito TE, Opoku-Anane J, Gonzalez A, Robinson J, Taffel M. OB/GYN, The George Washington University, Washington, District of Columbia Study Objective: Deeply infiltrative endometriosis (DIE) causes intraabdominal scarring with involvement of pelvic viscera, pelvic pain, and the need for surgical intervention. We retrospectively reviewed the accuracy of our endometriosis MRI protocol at The George Washington University Hospital (GWUH) in identifying the extent and location of DIE. Design: Retrospective Study. Setting: Large academic metropolitan gynecology practice. Patients: Women age 23 to 51 years old who had an endometriosis protocol pelvic MRI for suspected DIE and subsequently underwent laparoscopy by a single minimally invasive gynecologic surgeon. Intervention: Our MRI endometriosis protocol uses a 1.5T machine which takes images in T2, T1 non fat saturation, and a fat saturation T1 in axial orientation along all three planes pre and post-contrast. Thin slices were used with T1 images in 3mm and T2 in 4mm sections, respectively. Intraoperative data was collected for women who underwent surgery for endometriosis. Measurements and Main Results: Twenty-five patients were identified who met criteria and had laparoscopy for suspected DIE based on: 1) preoperative examination showing a rectovaginal mass or nodularity, nonmobile uterus fixed to rectum, and/or adnexal mass 2) severe or cyclic dysuria,dyschezia, or dyspareunia, or 3) a history of prior surgery for advanced staged endometriosis. Of these patients, fifteen were found to have DIE, two were found to have superficial endometriosis. Eight were found to have other pelvic pathology such as fibroids, abscesses or cysts. We found that for patients with a high preoperative suspicion of DIE, our MRI protocol showed a sensitivity of 80%, specificity of 38%, PPV of 70%, NPV of 50%. Conclusion: Our standardized endometriosis MRI protocol may predict the extent of DIE and may serve as an adjuvant test to inform preoperative planning and patient counseling.
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44
Measurements and Main Results: Tumoral markers levels were measured in blood samples obtained in the follicular phase of menstrual cycle. In 24 patients with stage I endometriosis (9,8%), according to ASRM classification, CA 125 mean value was 19,42 (IC 95% 14,17-24,67), while CA 19.9 mean value was 18,2 (IC 95% 8,86-27,54). For the 10 patients with stage II endometriosis (4,09%), mean values were respectively 22,5 (IC 95% 10,44-34,56) and 21,63 (IC 95% 11,6442,69). Among 113 patients with stage III endometriosis (46,31%) CA 125 mean value was 55,56 (IC 95% 44,13-66,99), and CA 19.9 46,32 (IC 95% 33,53-59,12); among 97 patients with stage IV of disease (39,75%) mean values were respectively 90,89 (IC 95% 75,10-106,67) and 54,70 (IC 95% 39,19-70,22). A significant positive correlation between the stage of disease and serum markers values was found (p\0,05). In particular, CA 125 mean value gets higher than CA 19.9 for each stage of endometriosis. Conclusion: these results support the hypothesis that both markers analyzed are related to the rAFS score and to the disease stage. The correlation is stronger for CA 125. Further studies are required.
124 Abstract Withdrawn
125
Open Communications 6 - Endometriosis (3:32 PM - 3:37 PM)
Appendiceal Endometriosis: Associations and Risk Factors Moulder JK,1 Jarvis EG,2 Melvin K,1 Hobbs KA,1 Siedhoff MT.1 1 Obstetrics and Gynecology, Division of Advanced Laparoscopy and Pelvic Pain, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; 2Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina Study Objective: Identify incidence of appendiceal pathology and risk factors for appendiceal endometriosis. Design: Retrospective cohort. Setting: University tertiary referral center. Patients: 227 women undergoing gynecological surgery for benign indications in our division between 2010d2013. Intervention: Coincidental appendectomy performed at the time of benign gynecologic surgery. Measurements and Main Results: Demographic, operative and histopathologic data were abstracted from medical records. Univariate and bivariate analyses were performed as appropriate. Logistic regression analysis was performed with pathologic diagnosis of appendiceal endometriosis (AE) as the primary outcome. Mean patient age was 36.8 years (+/- 9.6) and BMI 29.6kg/m2 (+/- 9). Pelvic pain was the most common indication for surgery (47%) and laparoscopic hysterectomy the most common primary procedure (60%). Although most appendices had a normal appearance (60%), 59% of these were assigned a pathologic diagnosis on final examination (including benign variants). 37% of patients had endometriosis diagnosed intraoperatively, and 46% of these women had deep infiltrating endometriosis (DIE). AE was present in 16% of all women with endometriosis, and in 28% of those with DIE. Two patients experienced a minor complication during appendectomy with no significant consequences. On bivariate analysis, AE was associated with nulliparity (p= 0.04), surgical diagnosis of endometriosis or DIE (p=0.001), and abnormal appearance (p=0.02). On regression analysis, patients with DIE had 7.7 times the odds of AE (95%CI: 2.1, 28.9; p=0.003), controlling for race, parity, appendiceal appearance and surgery indication. Conclusion: Coincidental appendectomy is a safe procedure to perform at time of benign gynecological surgery. Coincidental appendectomy as part of definitive treatment for DIE should be considered given the increased odds of AE in these patients.
126
Open Communications 6 - Endometriosis (3:38 PM - 3:43 PM)
What Are We Missing? The Role of Expert Transvaginal Ultrasound in the Diagnosis of Endometriosis Agarwal S,1 Fraser MA,2 Chen I,1 Singh SS.1 1Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, OHRI, Ottawa, Ontario, Canada; 2Department of Medical Imaging, The Ottawa Hospital; University of Ottawa, Ottawa, Ontario, Canada Study Objective: To compare expert guided transvaginal ultrasound (ETVUS) to routine trans vaginal ultrasound (TVUS) for the diagnosis of endometriosis. Design: ERB-approved retrospective chart review of surgically confirmed endometriosis cases undergoing both ETVUS and routine TVUS for the same indication. Setting: Canadian tertiary centre specializing in diagnosis and management of endometriosis. Patients: All cases with surgically confirmed endometriosis and an expert directed endometriosis ultrasound completed at our centre were included for review. Findings from the expert ultrasound were compared to routine pelvic ultrasound performed for the same indication. Measurements and Main Results: 40 cases met inclusion criteria. Mean patient age at first surgical diagnosis was 31 7 years. Dysmenorrhea (77%) and chronic pelvic pain (74%) were the most common presenting symptoms. Sensitivity of routine TVUS was 25% (10/40), compared to 78% (31/40) with ETVUS, (P \0.01). Comparisons were made based on the site and type of lesion. TVUS and ETVUS detected bladder involvement in (0/40) vs. 5% (2/40); ureter (0/40) vs. 8% (3/40); ovary 25% (10/40) vs. 73% (29/40); retrocervical area (0/40) vs. 60% (24/40), rectosigmoid 5% (2/40) vs. 78% (31/40), respectively. Specific endometriotic lesions recognized by TVUS versus ETVUS, were: ovarian endometriomas in 25% (10/40) vs. 45% (18/40), adhesions leading to distorted anatomy in 3% (1/40) vs. 78% (31/40); endometriotic implants or plaques in 3% (1/40) vs. 70% (28/40); and endometriotic nodules in 3% (1/40) vs. 35% (14/40), respectively. Routine TVUS diagnosis relied on the presence or absence of endometrioma (10/10), whereas ETVUS showed additional sites of disease in 97% (30/31) patients. Conclusion: Expert guided transvaginal ultrasound is more sensitive than routine transvaginal ultrasound to diagnose endometriosis, identifying lesions other than endometrioma, and is of assistance in surgical planning and patient counseling. Our future goal is to develop a simplified ETVUS technique for routine use.
127
Open Communications 6 - Endometriosis (3:44 PM - 3:49 PM)
Hospital-Related Costs for Endometriosis in Canada Allaire C,1 MacRae GS,2 Nishi C,2 Chen I.3 1Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; 2Performance Measurement & Reporting, Provincial Health Services Authority, Vancouver, British Columbia, Canada; 3Department of Obstetrics and Gynecology, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Study Objective: To determine the hospital-related costs associated with women requiring surgery or in-patient admission for endometriosis in Canada in recent years. Design: In this population-based cross-sectional study, women who had inpatient admission or surgery for endometriosis were identified using the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD). Surgical interventions were categorized as laparoscopy, adnexal surgery, hysterectomy, or other. Cases were categorised by intervention, age group, and geographical location. Resource intensity weights (RIW) were extracted. Cost per weighted case methodology was used to determine costs. Setting: Hospitals treating women with endometriosis in Canada.
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44 Patients: Women aged 15-59 with a most responsible International Classification of Diseases diagnosis of endometriosis identified using the CIHI-DAD who were discharged from hospital from April 1, 2008 to March 31, 2013. Measurements and Main Results: Over five years , there were 57,879 cases of surgery or in-patient admission with a major diagnosis of endometriosis for a total cost of $186,333,987 (mean $37,266,797/year). The national incidence of hospitalization was 0.7 per 1000 female ageadjusted population and remained stable over the study period . 24,724 (42.7%) of cases were hysterectomies at a cost of $106,310,091; 12,089 (20.9%) were adnexal surgeries costing $42,339,017; 16,524 (28.5%) were laparoscopic procedures costing $25,274,630; 3,392 (5.9%) were admissions for other procedures costing $9,897,474; and 1,150 (2.0%) were admissions with no procedure costing $2,272,514. Incidence of hysterectomy was highest among ages 40-44, while incidence of laparoscopy was highest among ages 30-34. Conclusion: The hospitalization rate for endometriosis remained stable over the study period . The most common reason for admission was hysterectomy. The economic burden of in hospital treatment for endometriosis in Canada is substantial. 128
Open Communications 6 - Endometriosis (3:50 PM - 3:55 PM)
Urine Peptidome for Noninvasive Diagnosis of Endometriosis: A Preliminary Study Liu H, Shi H, Fan Q. Obstetrics & Gynecology, Peking Union Medical College Hospital, Beijing, China Study Objective: To detect endometriosis by urine peptide biomarkers using magnetic beads-based matrix-assisted laser desorption/ionization time-offlight mass spectrometry (MALDI-TOF-MS) and to identify interesting peptides using liquid chromatography tandem mass spectrometry. Design: Prospective case-control study. Setting: University-based gynecological department and central laboratory. Patients: A total of 122 patients suffering from dysmenorrhea, pelvic pain and infertility were enrolled in the study. Intervention: Urine samples were collected before laparoscopy. Urine samples were analyzed by the MALDI-TOF technique to generate peptide profiling and ClinProTools software was used to set up a diagnostic model for endometriosis. Liquid chromatography tandem mass spectrometry (LC–MS/MS) was used to identify interesting peptides. Measurements and Main Results: At laparoscopy 60 patients were diagnosed with endometriosis and 62 patients were disease-free. There were 36 different peptides expressed in endometriosis patients detected by MALDI-TOF compared with controls. We established a genetic algorithm as a diagnostic model with the combination of five peptides (m/z = 1433.9, 1599.4, 2085.6, 6798.0 and 3217.2). The model showed a sensitivity of 90.9% and specificity of 92.9%. Urine from another 26 symptomatic patients before laparoscopy were randomly selected and analyzed accordingly. A genetic algorithm showed a sensitivity of 90.9% and specificity of 92.9% in predicting endometriosis before laparoscopy. We also identified two peptides not belonging to the diagnostic model as collagen precursors. Conclusion: Patients with endometriosis have a unique cluster of peptides in urine. Peptide proteomic profiling provides a novel method for noninvasive diagnosis of endometriosis. 129
Open Communications 6 - Endometriosis (3:56 PM - 4:01 PM)
Repeat Surgery for Endometriosis-Related Pelvic Pain: Pain Scores and Number of Lesions Benjamin AR, Howard FM. Department Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York Study Objective: To evaluate the presence and amount of endometriosis at repeat surgery for persistent or recurrent endometriosis-associated pelvic pain.
S37
Design: A pilot, retrospective study of all patients who underwent repeat surgery for endometriosis-associated pelvic pain. Setting: A university-based chronic pelvic pain clinic. Patients: 59 (24%) of 250 had repeat surgery for endometriosis-associated pelvic pain during the study period. Of these, 32 had intake data that allowed evaluation of measured variables at the time of initial and repeat surgeries. Intervention: All patients had surgical evaluation and treatment for endometriosis-associated pelvic pain. Measurements and Main Results: Average pain levels were not different before the 1st and 2nd surgeries. The average interval between the 1st and 2nd surgery was 19 months, and the mean duration of pain relief after the 1st surgery was 7 months. Postoperative pain relief, defined as at least 30% decrease in pain levels, was 66% with first surgery, compared to 40% with second surgery (odds ratio 2.9, 95% CI 1.0 - 8.0, p = .05). The presence of other co-morbid pain diagnoses did not associate with postoperative pain relief. 81% of patients had fewer endometriosis lesions at 2nd surgery than at 1st surgery. The mean number of endometriosis lesions at 1st surgery was 5.4 3.2 and at the 2nd surgery was 2.4 1.9 (p \ .001). Of the 14 patients who had hysterectomies, 71 % achieved significant pain relief, compared to 19% of those who did not have hysterectomies (p = .004). Conclusion: Although pain levels were the same prior to initial and repeat surgeries, 80% of patients had fewer lesions at repeat surgery. Significant pain relief was less likely after repeat surgery as compared to the initial surgery. Patients who had hysterectomy as part of their surgical treatment were more likely to have pain relief.
130
Open Communications 6 - Endometriosis (4:02 PM - 4:07 PM)
Diagnosis of Deeply Infiltrative Endometriosis: Accuracy of a Specific Magnetic Resonance Imaging Protocol Ito TE, Opoku-Anane J, Gonzalez A, Robinson J, Taffel M. OB/GYN, The George Washington University, Washington, District of Columbia Study Objective: Deeply infiltrative endometriosis (DIE) causes intraabdominal scarring with involvement of pelvic viscera, pelvic pain, and the need for surgical intervention. We retrospectively reviewed the accuracy of our endometriosis MRI protocol at The George Washington University Hospital (GWUH) in identifying the extent and location of DIE. Design: Retrospective Study. Setting: Large academic metropolitan gynecology practice. Patients: Women age 23 to 51 years old who had an endometriosis protocol pelvic MRI for suspected DIE and subsequently underwent laparoscopy by a single minimally invasive gynecologic surgeon. Intervention: Our MRI endometriosis protocol uses a 1.5T machine which takes images in T2, T1 non fat saturation, and a fat saturation T1 in axial orientation along all three planes pre and post-contrast. Thin slices were used with T1 images in 3mm and T2 in 4mm sections, respectively. Intraoperative data was collected for women who underwent surgery for endometriosis. Measurements and Main Results: Twenty-five patients were identified who met criteria and had laparoscopy for suspected DIE based on: 1) preoperative examination showing a rectovaginal mass or nodularity, nonmobile uterus fixed to rectum, and/or adnexal mass 2) severe or cyclic dysuria,dyschezia, or dyspareunia, or 3) a history of prior surgery for advanced staged endometriosis. Of these patients, fifteen were found to have DIE, two were found to have superficial endometriosis. Eight were found to have other pelvic pathology such as fibroids, abscesses or cysts. We found that for patients with a high preoperative suspicion of DIE, our MRI protocol showed a sensitivity of 80%, specificity of 38%, PPV of 70%, NPV of 50%. Conclusion: Our standardized endometriosis MRI protocol may predict the extent of DIE and may serve as an adjuvant test to inform preoperative planning and patient counseling.