Preoperative MRI Scoring System Could Ensure Women Are Fully Informed

The Deep Pelvic Endometriosis Index could ensure that women are fully informed about what to expect following deep pelvic endometriosis surgery.

Key Points

Highlights: 

• The Deep Pelvic Endometriosis Index (dPEI) can help predict surgery duration, hospital stay length, and postoperative complication risk. 

Importance:

• The "Deep Pelvic Endometriosis Index" assessed by MRI score not only helps clinicians to make the best decision regarding surgery but also fully informs patients about what to expect.

What’s done here:

• This is a validation multicenter cohort study on 605 women who underwent deep pelvic endometriosis surgery for whom preoperative MRI data were available.

Key results:

• 61.2% of women had mild disease, 25.8% had moderate disease, and 13.1% had severe disease.
• 93.2% had central endometriosis and 31.2% had lateral endometriosis.
• A severe dPEI score was most commonly associated with lateral endometriosis.
• The median operating time and length of hospital stay were the longest in women with severe disease with 211 minutes and 6 days respectively.
• Patients with severe disease were 3.6 times more likely to experience severe complications following surgery.

Limitations:

• This is a retrospective study so there is a risk of bias and missing data.
• Patients included in the study were more likely to have severe disease because they were mostly referred by highly experienced tertiary centers.
• The number of patients with lateral pelvic wall endometriosis was relatively low.
• No long-term follow-up was performed, so data is lacking about the meantime of intermittent self-catheterization, pain relief, and fertility rate outcomes.

Lay Summary

The Deep Pelvic Endometriosis Index is able to predict the length of surgery and hospital stay as well as complications following surgery including voiding dysfunction, according to a new multicenter cohort study, the results of which were published in The Journal of the American Medical Association Network Open.

The index could, therefore, help clinicians to better anticipate the extent of deep pelvic endometriosis and improve the clinical management and counseling of patients.

Deep pelvic endometriosis surgery is complex. So mapping the disease before the operation is very important.

In the present study, a team of researchers from France led by Dr. Pascal Rousset of the Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital in Lyon, and Claude Bernard University in Pierre Bénite evaluated the Deep Pelvic Endometriosis Index magnetic resonance imaging score in a multicenter cohort of 605 patients, mean age 33.3 years who underwent deep pelvic endometriosis surgery between January 1, 2019 and December 31, 2020. 

The results showed that the majority (61.2%) of women had a mild deep pelvic endometriosis index score while 25.8% had a moderate score and 13.1% had a severe score. 

Almost all women (93.2%) had central endometriosis while 31.2% had lateral endometriosis. The latter was more common in women with a severe deep pelvic endometriosis index score compared to those with a moderate score and again more common in women with a moderate score compared to those with a mild score. 

The median operating time was 211 minutes and the medium hospital stay was 6 days in women who had a severe dPEI score. These times were shorted in women with a moderate dPEI score with a median operating time of 150 minutes and a median hospital stay of 4 days. Finally, the median operating time for women with a mild dPEI score was 110 minutes and the median hospital stay was 3 days. 

Patients with severe deep pelvic endometriosis were 3.6 times more likely to experience severe complications following the operation compared to those with mild or moderate disease. These patients were also more likely to experience postoperative voiding dysfunction.

The authors concluded that the dPEI score is a good way of mapping deep pelvic endometriosis preoperatively.

The dPEI score was calculated by allocating one point per compartment where a deep pelvic endometriosis lesion was seen and an extra point when an endometriotic lesion involved the pelvic wall in the lateral compartment, another extra point if a lesion was found in the vagina or in the lower part of the bladder base, and another extra point if ureteral dilatation was observed. A score of 2 or less was considered mild, a score of 3 or 4 was considered moderate and a score of 5 or more was considered severe.

Research Source: https://pubmed.ncbi.nlm.nih.gov/37140921/