Excise pelvic lesions to confirm endometriosis. (Miminal Disease Tough to Spot Clinically).

SAN DIEGO -- It's better to rely on surgical resection than eyesight alone when trying to determine whether a pelvic lesion is endometriosis, Dr. Pamela Stratton said at the World Congress on Endometriosis.

A study of lesions excised from 67 women surgically treated for endometriosis found some associations between visual characteristics and the disease but not enough to predict its presence in any one lesion, said Dr. Stratton, chief of the gynecology and obstetric consult service at the National Institutes of Health Clinical Center, Bethesda, Md.

Most diagnoses of endometriosis rely primarily on visual inspection, which seems potentially fraught with error, according to the study's results. "In women with minimal disease it's often difficult to distinguish some of the subtle appearances [of endometriosis] from other inflammation or diseases," so surgeons should excise all suspected lesions to ensure a histologic diagnosis of endometriosis, Dr. Stratton said.

She and her associates studied 312 lesions excised using a Neodymium: YAG contact laser from 67 women with chronic pelvic pain participating in a randomized, controlled trial of an experimental adjuvant drug therapy. Surgeons noted the location, width, depth, and color of each lesion as it was removed. Overall, 60% of the lesions proved to be endometriosis on histology.

A total of 64% of the lesions came from the cul-de-sac, the uterosacral ligaments, ...