Magnetic resonance imaging classification of deep pelvic endometriosis: description and impact on surgical management

Thomassin‐Naggara, Isabelle; Lamrabet, Samia; Crestani, Adrien; Bekhouche, Asma; Wahab, Cendos Abdel; Kermarrec, E.; Touboul, Cyril; Daraı̈, Émile

doi:10.1093/humrep/deaa103

Cited by 53 publications

(42 citation statements)

References 27 publications

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“…Recent literature has also evaluated inter-reader agreement with this classification, showing varying results; Thomassin-Naggara et al’s trial (2020) consisted of 150 cases affected by DIE. They found excellent inter-reader agreement for A and C compartments but poor agreement for the B compartment, in accordance with previous publications by Saba et al (2010) and Bazot et al (2011) [ 29 , 30 , 31 ]. On the other hand, the recent trial conducted by Burla et al (2020), which consisted of 21 cases of DIE, showed an overall lower concordance, with a particularly weak inter-rater agreement for compartment C [ 32 ].…”

Section: Discussionsupporting

confidence: 90%

Can New ENZIAN Score 2020 Represent a Staging System Improving MRI Structured Report?

Manganaro

Celli

Dolciami

et al. 2021

IJERPH

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Structured reporting systems for endometriotic disease are gaining a central role in diagnostic imaging: our aim is to evaluate applicability and the feasibility of the recent ENZIAN score (2020) assessed by MRI. A total of 60 patients with suspected tubo–ovarian/deep endometriosis were retrospectively included in our study according to the following criteria: availability of MR examination; histopathological results from laparoscopic or surgical treatment; patients were not assuming estro-progestin or progestin therapy. Three different readers (radiologists with 2-, 5-, and 20-years of experience in pelvic imaging) have separately assigned a score according to the ENZIAN score (revised 2020) for all lesions detected by magnetic resonance imaging (MRI). Our study showed a high interobserver agreement and feasibility of the recent ENZIAN score applied to MRI; on the other hand, our experience highlighted some limitations mainly due to MRI’s inability to assess tubal patency and mobility, as required by the recent score (2020). In view of the limitations which arose from our study, we propose a modified MRI-ENZIAN score that provides a complete structured reporting system, more suitable for MRI. The high interobserver agreement of the recent ENZIAN score applied to MRI confirms its validity as a complete staging system for endometriosis, offering a shared language between radiologists and surgeons.

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Section: Discussionsupporting

confidence: 90%

Can New ENZIAN Score 2020 Represent a Staging System Improving MRI Structured Report?

Manganaro

Celli

Dolciami

et al. 2021

IJERPH

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“…Eligibility criteria included women aged between 18 and 50 years, with one or more deep endometriotic nodules defined as infiltration greater than 1.5 cm in diameter, equivalent to grade 2 (invasion 1 e 3 cm) or grade 3 (invasion >3 cm) of the ENZIAN classification (Thomassin‐Naggara et al, 2020) evaluated with magnetic resonance imaging. Although deep endometriosis is defined as infiltration for more than 0.5 cm, we included only cases with more than 1.5 cm to minimize false‐positive imaging diagnosis.…”

Section: Methodsmentioning

confidence: 99%

A single‐blind, randomized, pilot study of a brief mindfulness‐based intervention for the endometriosis‐related pain management

Moreira

Gamboa

Oliveira

2022

European Journal of Pain

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“…Di Paola et al ( 2015 ) and Burla et al ( 2019 ) compared MRI findings with surgical findings using the Enzian classification and found good agreement between surgical and MRI Enzian classifications. Thomassin-Naggara et al ( 2020 ) showed that the Enzian classification based on MRI findings is reproducible and correlates with surgical findings. Their retrospective observational study included 150 patients with DE that underwent MRI and subsequent surgery.…”

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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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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Magnetic resonance imaging classification of deep pelvic endometriosis: description and impact on surgical management

Abstract: Abstract STUDY QUESTION Is an MRI classification of deep pelvic endometriosis (DE) able to correctly predict the risk of DE surgery. SUMMARY ANSWER A new radiological classification, that we have called the deep pelvic endometriosis index (dPEI) classification, is… Show more

Cited by 53 publications

References 27 publications

Can New ENZIAN Score 2020 Represent a Staging System Improving MRI Structured Report?

Can New ENZIAN Score 2020 Represent a Staging System Improving MRI Structured Report?

A single‐blind, randomized, pilot study of a brief mindfulness‐based intervention for the endometriosis‐related pain management

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

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