Diagnostic Benefit of the Detection of Mitotic Figures in Endometriotic Lesions

Abstract

Objectives Endometriosis is a chronic disease which is diagnosed by surgical intervention combined with a histological work-up. Current international and national recommendations do not require the histological determination of the proliferation rate. The diagnostic and clinical importance of the mitotic rate in endometriotic lesions still remains to be elucidated.

Methods In this retrospective study, the mitotic rates and clinical data of 542 patients with histologically diagnosed endometriosis were analyzed. The mean patient age was 33.5 ± 8.0 (17 – 72) years, and the mean reproductive lifespan was 21.2 ± 7.8 (4 – 41) years. Patients were divided into two groups and patientsʼ reproductive history and clinical endometriosis characteristics were compared between groups. The study group consisted of women with confirmed mitotic figures (n = 140, 25.83%) and the control group comprised women without proliferative activity according to their mitotic rates (n = 402, 74.27%).

Results Women with endometriotic lesions and histologically confirmed mitotic figures were significantly more likely to have a higher endometriosis stage (p = 0.001), deep infiltrating endometriosis (p < 0.001), ovarian endometrioma (p = 0.012), and infertility (p = 0.049). A mitotic rate > 0 was seen significantly less often in cases with incidental findings of endometriosis (p = 0.031). The presence of symptoms and basic characteristics such as age, age at onset of menarche, reproductive lifespan and parity did not differ between the group with and the group without mitotic figures.

Conclusion This study shows that a simple histological assessment of the mitotic rate offers additional diagnostic value for the detection of advanced stages of endometriosis. The possible role as a predictive marker for the recurrence of endometriosis or the development of endometriosis-associated cancer will require future study.

Zusammenfassung

Ziele Endometriose ist eine chronische Erkrankung, die durch einen chirurgischen Eingriff und einen histologischen Nachweis diagnostiziert wird. Laut den aktuellen internationalen und nationalen Empfehlungen ist der histologische Nachweis der Proliferationsrate nicht nötig. Die diagnostische und klinische Bedeutung der Mitoserate in endometriotischen Läsionen ist immer noch ungeklärt.

Methoden In dieser retrospektiven Studie wurden die Mitoseraten und die klinischen Daten von 542 Patientinnen mit histologisch nachgewiesener Endometriose analysiert. Das durchschnittliche Alter der Patientinnen betrug 33,5 ± 8,0 (17 – 72) Jahre, und ihre durchschnittliche Reproduktionsspanne lag bei 21,2 ± 7,8 (4 – 41) Jahren. Die Reproduktionsgeschichte und klinischen Endometriosemerkmale wurden verglichen. Die Studiengruppe bestand aus Frauen, bei denen Mitosefiguren nachgewiesen wurden (n = 140, 25,83%), und die Kontrollgruppe bestand aus Frauen ohne Proliferationsaktivität (n = 402, 74,27%).

Ergebnisse Frauen mit endometriotischen Läsionen und einem histologischen Nachweis von Mitosefiguren hatten signifikant häufiger ein klinisch höheres Endometriosestadium (p = 0,001), tief infiltrierende Endometriose (p < 0,001), ovarielle Endometriome (p = 0,012) oder Infertilität (p = 0,049). Frauen, bei denen eine Endometriose als Zufallsbefund entdeckt wurde, hatten signifikant weniger oft eine Mitoserate von > 0 (p = 0,031). Es gab keine Unterschiede in den Symptomen und Charakteristika wie Alter, Menarche, Reproduktionsspanne und Parität zwischen der Gruppe mit und der Gruppe ohne Mitosefiguren.

Schlussfolgerung Diese Studie zeigt, dass eine einfache histologische Evaluierung der Mitoserate für die Erkennung einer Endometriose im fortgeschrittenen Stadium einen diagnostischen Mehrwert bietet. Um die Bedeutung der Mitoserate als prädiktiven Marker für das Wiederauftreten einer Endometriose bzw. für die Entwicklung von endometrioseassoziiertem Krebs zu evaluieren, werden weitere Untersuchungen benötigt.

Key words

endometriosis - mitotic rate - infertility - laparoscopy - endometriosis-associated ovarian cancer

Schlüsselwörter

Endometriose - Mitoserate - Infertilität - Laparoskopie - endometrioseassoziiertes Ovarialkarzinom

Publication History

Received: 22 April 2021

Accepted after revision: 05 August 2021

Article published online:
10 January 2022

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