527: Beyond the Surgeon's Eye: Solving the Pathology-Visual Disconnect in Endometriosis Surgery

Sunday, November 15, 2026
2:00 pm - 3:00 pm

Room: RM302

Chairs: Tarek Toubia, Erin T. Carey

Faculty: Tarek Toubia, Erin T. Carey, Lori Scanga, Tamer Seckin

Description: Every endometriosis surgeon faces a diagnostic dilemma: compelling visual disease that tests negative on pathology, or conversely, uncertain-appearing tissue that proves pathologically positive. These scenarios create clinical uncertainty, delay diagnosis, and leave every surgeon grappling with a fundamental dilemma: how to avoid both unnecessary excisions of benign tissue and missed excisions of true endometriosis.

This panel brings together experienced endometriosis surgeons and a gynecologic pathologist to dissect both sides of this mismatch—why it happens, how to minimize its occurrence, and most importantly, how to navigate it clinically when it does occur.

The panel will: Present the dual diagnostic problem-Scenario A: Visually classic endometriosis that returns negative pathology and Scenario B: Uncertain or atypical lesions that could prove positive; Showcase real surgical findings through case-based presentations featuring intraoperative images and descriptions of lesion characteristics, location, and surgeon impression; Engage the audience interactively by presenting surgical findings and polling participants on their predicted pathology results—then revealing the actual pathologic outcomes;  Review the pathologic evidence of key endometriosis variants—explaining why standard H&E staining misses certain presentations and what enhanced pathology protocols can detect; and Provide actionable strategies for optimizing specimen collection, requesting enhanced pathology workup, and improving surgeon-pathologist communication.

Why this matters: Negative pathology should not be interpreted as unnecessary excision. Conversely, uncertain lesions warrant thoughtful evaluation as dismissing them outright risks missing true disease. Understanding this science improves diagnostic confidence, reduces delayed diagnoses, and strengthens the collaboration of gynecologic surgeons with pathologists.

Learning Objectives: At the end of this course, the participant will be able to:

1. Recognize dual diagnostic scenarios, understand their incidence, and recognize clinical implications. Participants will recognize and distinguish between the two key diagnostic paradoxes in endometriosis (negative pathology on visually compelling disease AND positive pathology on uncertain lesions) and will articulate the incidence and clinical implications of each using evidence from the literature;
2. Explain the pathologic mechanisms underlying false-negative diagnoses in endometriosis Participants will explain at least three specific pathologic mechanisms that result in false-negative endometriosis diagnoses despite true disease being present—thereby understanding the molecular and cellular basis for why standard H&E staining fails to identify certain endometriosis variants; and
3. Apply evidence-based strategies to optimize pathology yield and improve diagnostic accuracy Participants will apply evidence-based strategies to maximize endometriosis diagnostic accuracy by (1) modifying intraoperative specimen collection technique, (2) requesting enhanced pathology workup, and (3) interpreting negative standard histology in clinical context, thereby enabling them to make more accurate endometriosis diagnoses, reduce false-negatives, and improve communication between gynecologic surgeons and pathologists.

COURSE OUTLINE

2:00 PM Welcome, Introduction and Course Overview

T. Toubia

2:05 PM When What We See Doesn't Match What We Get: The Endometriosis Diagnostic Paradox in the OR

T. Toubia

2:15 PM From Mismatch to Management: Practical Strategies to Improve Endometriosis Diagnostic Accuracy

E. Carey

2:25 PM Why Pathology Says 'No' When It Should Say 'Yes'

L. Scanga

2:35 PM The Disease We Don't See: Occult Endometriosis and the Limits of Visual Diagnosis

T. Seckin

2:45 PM Discussion Questions & Answers

3:00 PM Adjourn