03/24/2026
Pathology didn't show endo, now what?
A negative surgical pathology result doesn't mean you don't have endometriosis
If the biopsy is negative, a few things could be going on:
✅️ The lesion was endometriosis, but the tissue got damaged in the removal process (thermal, etc)
✅️ The lesion was endometriosis in the past, but is now just fibrosis
✅️ OR, maybe the area actually wasn't endo. Thorough surgeons err on the side of removing EVERYTHING that looks abnormal, and sometimes we are wrong.
When I label tissue specimens, if I'm pretty sure it's endometriosis, I call the specimen "endometriosis." If I'm not sure, I call it "possible endometriosis." That way, if the surgical pathology comes back negative, I can say, "I'm pretty confident you have it even though the pathology was negative," or "I'm honestly not sure."
Please send this to a friend who was disappointed after surgery, or a pediatrician, P*P, or OB/GYN who may need to hear this 🙏
Also, ACOG, "a biopsy should be considered," is pretty weak wording. They do go on to say, "ideally lesions are treated at the time of diagnosis, so patients don't have to undergo a subsequent surgery." Unfortunately they don't specify excision.
*p
