Pelvic endometriosis: Cytology of the peritoneal fluid as a marker in the diagnosis

Endometrosis pélvica: Citología del líquido peritoneal como marcador en el diagnóstico

Pelvic endometriosis is currently a disease whose etiology and pathogenesis remain unclear. The macroscopic diagnosis and clinical classification are made by videolaparoscopy and anatomopathological study. The peritoneal fluid cytology can provide a diagnostic alternative with the benefit of being less invasive than the biopsy. Forty-five patients undergoing laparoscopy at the Gynecology and Obstetrics Department of the Hospital of San José were chosen. Patients with traumatic punctures were excluded from the study so as not to alter the cytology results. The peritoneal fluid was obtained by aspiration of the Douglas pouch or by peritoneal lavage with saline solution. In addition, biopsies of the uterosacral ligaments were taken. Samples for cytology were fixed and stained for iron and cell count. To the biopsy material, Anointing with Prussian blue was performed. Cytology was considered positive due to the presence of hemosiderophages or positive cell count. When analyzing the value of peritoneal fluid cytology as a diagnostic test for endometriosis, taking the anatomopathological study as a gold test, it was found to have a sensitivity of 93.3% and a specificity of 86.6%, a positive predictive value of 77%. We propose this method as an adjuvant element in the diagnosis of endometriosis, to replace the anatomopathological study, since it is less invasive and with less risk of causing intraoperative injuries.

1. Duleva-Antoni J. Diagnóstico de la endometriosis. Clínicas de ginecología y obstetricia. 1997; 2: 299.

2. Roberto M, Nava y Sánchez. Endoscopia quirúrgica Ginecológica. Estudio del líquido peritoneal y biopsia por laparoscopia. 1997: 93.

3. Cohen M.R. Biopsy via periotneoscopY. J Reprod Med 1997; 1:436

4. Jacobson L. Objetivized diagnosis of endometriosis. Am J Obstet Gynecol 1993; 105: 1088

5. Chow AW, Malkasian KL, Marshall J.M. The bacteriology of the endometriosis. Am J Obstet Gynecol 1995; 122: 876

6. Chaparro MV, Ghosh S, Nashe A. Laparoscopy for the confirmation and prognostic of the endometriosis. Int J Ginecol Obstet 1998; 15: 307

7. Muscato I. Citología de líquido peritoneal. Journal Español de Ginecología 1995; 2:126.

8. Halme J. Becker S, Wing R. Accentuated cyclic activation of peritoneal macrophages in patients with endometriosis. Am J Obstet Gynecol 1994; 85: 148.