Comparison between Sonography-based and Surgical Extent of Deep Endometriosis Using the Enzian Classification - A Prospective Diagnostic Accuracy Study

Hudelist, Gernot; Montanari, Eliana; Salama, Mamdouh M.; Dauser, Bernhard; Németh, Zoltán; Keckstein, J

doi:10.1016/j.jmig.2021.02.009

Cited by 33 publications

(33 citation statements)

References 19 publications

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“…First, MRI measurements of the size of DE affecting the B compartment (uterosacral ligaments, parametrium) are poorly reproducible, and secondly MRI findings of lesions in the B-compartment show poor concordance with surgical findings. Similarly, measurements of parametrial DE by TVS, which have been investigated in only one study ( Hudelist et al, 2021 ) are less reliable (when compared with surgical findings) than measurements of lesions in the A, C and FB compartments. In favour of the Enzian system, there is increasing evidence that the Enzian classification can predict surgical complexity and complications.…”

Section: Discussionmentioning

confidence: 99%

“…Hudelist et al ( 2019 ) evaluated the lesion location and size according to the Enzian classification by using preoperative TVS. They compared the ultrasound results with surgical findings in 195 women with DE and found good agreement between ultrasound and surgical findings especially for Enzian compartments A, C and FB.…”

Section: The Enzian and (#) Enzian Classificationsmentioning

confidence: 99%

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What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis

Hudelist¹,

Valentin²,

Sarıdoğan³

et al. 2021

Facts Views Vis ObGyn

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Background: Endometriosis is a common benign gynaecological disease that affects pelvic structures and causes adhesions. Endometriosis outside the pelvis exists but is rarer. Deep endometriosis may affect organs such as the urinary bladder, ureters, bowel and sacral roots. Adenomyosis (growth of endometrium in the myometrium, sometimes explained by disruption of the uterine junctional zone) frequently co-exists with deep endometriosis. Over the past decades, multiple attempts have been made to describe the anatomical extent of endometriosis. Out of approximately 20 classification systems suggested and published so far, three have gained widespread acceptance. These are the rASRM (American Society of Reproductive Medicine) classification, the Endometriosis Fertility Index (EFI) and the Enzian classification. Ideally, a classification system should be useful both for describing disease extent based on surgical findings and results of imaging methods (ultrasound, magnetic resonance imaging). Objectives: To highlight the advantages and disadvantages of the three classification systems. Methods: This is a narrative review based on selected publications and experience of the authors. We discuss the current literature on the use of the rASRM, EFI and Enzian classification systems for describing disease extent with imaging methods and for prediction of fertility, surgical complexity, and risk of surgical complications. We underline the need for one universally acceptable terminology to describe the extent of endometriosis. Conclusions: A useful classification system for endometriosis should describe the sites and extent of the disease, be related to surgical complexity and to disease-associated symptoms, including subfertility and should satisfy needs of both, imaging specialists for pre-operative classification and surgeons. The need for such a system is obvious and is provided by the #Enzian classification. Future research is necessary to test its validity.

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Section: Discussionmentioning

confidence: 99%

Section: The Enzian and (#) Enzian Classificationsmentioning

confidence: 99%

What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis

Hudelist¹,

Valentin²,

Sarıdoğan³

et al. 2021

Facts Views Vis ObGyn

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“…Its revision was published in 2011. Several studies recognized it as a valid and suitable tool for mapping endometriosis lesions in ultrasonography (USG)/ magnetic resonance imaging (MRI) and surgical settings [8][9][10]. The new update of Enzian, also called #Enzian 2021 created through a consensus process, is a comprehensive visual documentation system for a complete pictorial mapping of endometriosis including peritoneal endometriotic implants and extent of organ involvement by DIE, and is useful with both non-invasive diagnostic (USG/MRI) and laparoscopic methods, it also includes peritoneal, ovarian, and tubal lesions and extent of adnexal adhesions (Figure 1), thus providing a common language for better interpretation.…”

Section: Introductionmentioning

confidence: 99%

Pre-operative mapping and structured reporting of pelvic endometriotic lesions on dynamic ultrasound and its correlation on laparoscopy using the #ENZIAN classification

Bindra

Nori²,

Mohanty³

et al. 2022

Arch Gynecol Obstet

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Purpose: The objective of this study was to evaluate and compare the diagnostic performance of ultrasonography (USG) assessment using structured reporting with intraoperative laparoscopic assessment in deep in ltrating endometriosis (DIE) using the recent update of the #ENZIAN classi cation.Methods: This was a retrospective study conducted in Tertiary Multi-disciplinary Endometriosis Care Hospital over a period of 8 months which included 50 patients who underwent a planned laparoscopic endometriosis excisional surgery after a dedicated USG assessment using International Deep Endometriosis Analysis (IDEA) protocol and #Enzian score (updated Enzian classi cation), between Feb 2021 to Sept 2021 at Apollo Hospitals, Hyderabad. The pre-operative USG ndings were reported in a structured reporting format and intraoperative ndings were classi ed using the standard #ENZIAN classi cation. No prospective interventions were done. A review of pre-operative ultrasound and laparoscopic ndings as per the #Enzian.Results: Sensitivity and the negative predictive value of ultrasound were 86% and 84.2% for peritoneal lesions, 97% and 93.3 % for left ovarian lesions, 93% and 91.6% for right ovarian lesions, 91% and 84% for left tubal lesions, 90% and 86.3 % for right tubal lesions, 93% and 75 % for uterosacral ligaments, 93.3 % and 97% for rectal lesions and sensitivity and negative predictive values were 100 % for rectovaginal lesions, adenomyosis, and ureteric lesions as con rmed on laparoscopy.Conclusion: Dynamic ultrasound assessment with a structured report based on IDEA protocol and #ENZIAN score is accurate for mapping of pelvic endometriosis in all forms, and it correlates with laparoscopic ndings, thus helps surgeon for better planning and providing a road map for surgeons. From a clinical perspective, a uniform and shared reporting system across imaging and therapeutic modalities will simplify communication, improving patient management by conservative or surgical treatments, avoiding multiple repeat surgeries, and improving quality of treatment.

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“…Indeed, multiple international bodies advise the utilization of the IDEA consensus and the # ENZIAN classification in describing endometriosis on ultrasound [24]. The accuracy of TVUS in diagnosing endometriosis varies depending on ENZIAN compartments [24,25 ▪ ] and we will discuss each of the regions below.…”

Section: Standardising Ultrasounds For the Diagnosis And Classificati...mentioning

confidence: 99%

Effectiveness of ultrasound for endometriosis diagnosis

Chen-Dixon

Uzuner

Mak

et al. 2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewEndometriosis is a chronic benign gynaecological condition characterized by pelvic pain, subfertility and delay in diagnosis. There is an emerging philosophical shift from gold standard histopathological diagnosis through laparoscopy to establishing diagnosis through noninvasive imaging.Recent findingsThe ENZIAN classification system was updated in 2021 to be suitable for both diagnostic imaging and laparoscopy. The accuracy of transvaginal ultrasound (TVUS) in diagnosing endometriosis varies depending on location of the lesion. A recent international pilot study found that when ultrasound is performed in accordance with the IDEA consensus, a higher detection of deep endometriosis is seen, with an overall sensitivity of 88% and specificity of 79% compared with direct surgical visualization.SummaryAlthough ultrasound can detect adenomyosis, deep endometriosis and endometriomas, it is not possible to reliably detect superficial endometriosis. In the instance of a negative ultrasound with persistence of symptoms despite medical therapy, laparoscopy should be considered for diagnosis and treatment.

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Comparison between Sonography-based and Surgical Extent of Deep Endometriosis Using the Enzian Classification - A Prospective Diagnostic Accuracy Study

Cited by 33 publications

References 19 publications

What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis

What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis

Pre-operative mapping and structured reporting of pelvic endometriotic lesions on dynamic ultrasound and its correlation on laparoscopy using the #ENZIAN classification

Effectiveness of ultrasound for endometriosis diagnosis

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