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

Abstract

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.

The Diagnostic Accuracy of Transvaginal Ultrasound for Detection of Ureteral Involvement in Deep Infiltrating Endometriosis

“…Six articles ultimately remained to be analyzed in our meta-analysis. [15][16][17][18][19][20] Characteristics of Included Studies Table 1 summarizes the main characteristics of the primary studies included in our meta-analysis. Data about 834 patients was available.…”

“…Five studies included a non-consecutive series of patients. [15][16][17][18]20 In one study, this information was not reported. 19 The diagnostic test used to conduct these studies was a TVU, and all studies used laparoscopic surgical findings with histopathological confirmation as the reference test, our reference standard.…”

“…In four articles there was one single ultrasound expert examiner. 15,16,19,20 In one study, there were multiple observers, also stated as expert examiners. 18 One study did not report how many observers participated in the study.…”

Die #Enzian-Klassifikation für die nicht invasive und invasive Diagnostik der Endometriose

“…Eine sehr gute Übereinstimmung der sonografischen Klassifikation mit der #Enzian-Klassifikation (neue Klassifikation) mit der chirurgischen Klassifikation haben Di Giovanni et al in einer retrospektiven Studie nachgewiesen [18]. Dies bestätigten Montanari in einer prospektiven Multicenterstudie mit 745 Patienten aus 7 internationalen Zentren [19] und Bindra et al [20]. Frage 4…”

Effectiveness of ultrasound for endometriosis diagnosis

“…The ENZIAN classification was originally developed in 2003 but the latest update in 2021, called #ENZIAN, offers a comprehensive pictorial mapping of endometriosis and is suitable for both diagnostic imaging and laparoscopy [22]. The ENZIAN classification system locates the endometriosis into compartments: compartment A (vagina and rectovaginal septum), compartment B (uterosacral ligaments to pelvic floor), and compartment C (rectum and sigmoid colon) and has additional description for O (ovarian), T (tubo-ovarian complex), P (peritoneal), FA (adenomyosis), FB (urinary bladder), FU (ureter) and FI (intestinal) [22][23][24]. Figure 1 illustrates the #ENZIAN classification with overview of potentially affected organs and compartments.…”