250 Obstetrics and Gynecology Board Review •••
❍ The mean age of diagnosis of endometriosis is?
25 and 35.
❍ What is the best imaging technique for diagnosing endometriosis?
Laparoscopy remains the optimal method, but MRI using the fat-saturation technique has a PPV of 95% and
NPV of 50% with implants >4 mm.
❍ Does endometriosis have an ethnic predilection?
The prevalence of asymptomatic endometriosis may be somewhat lower in Blacks and higher in Asians than in
White women.
❍ True or False: The black powder lesions seen here in the posterior cul-de-sac should be biopsied to confirm
the diagnosis of endometriosis.
True. A biopsy is always recommended to confirm endometriosis on histology.❍ What are the ultrasound findings consistent with endometriosis?
Cystic structures with diffuse low-level internal echoes indicating a possible endometrioma.
❍ Does medical treatment of minimal-mild endometriosis increase fertility? How about surgical treatment?
No. Surgical treatment may increase fertility rates; therefore, it is still recommended at time of laparoscopy.
❍ Does preoperative medical treatment assist in surgical treatment of endometriosis?
Yes. It softens the endometrial implants for surgical removal.
❍ When does one achieve the highest pregnancy rates after surgical treatment?
In the first year, success is inversely related to the severity of disease.
❍ What are the recurrence rates after surgical treatment and after medical treatment?
For surgical tx: 10% in first year and 20% in 5 years.
For medical tx: 5% to 20% per year and 40% in 5 years.