The #Enzian classification: A comprehensive non‐invasive and surgical description system for endometriosis

Keckstein, J.; Sarıdoğan, Ertan; Ulrich, U.; Sillem, Martin; Oppelt, Peter; Schweppe, K.-W.; Krentel, Harald; Janschek, Elisabeth; Exacoustòs, C.; Malzoni, Mario; Mueller, Michael D.; Roman, Horace; Condous, G.; Forman, Axel; Jansen, Frank-Willem; Bokor, Attila; Simedrea, Voicu; Hudelist, Gernot

doi:10.1111/aogs.14099

Cited by 139 publications

(151 citation statements)

References 23 publications

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“…Jörg Keckstein et al have recently affirmed that the newly prosed ENZIAN score should be applied by surgeons, sonographers, and radiologists following the same principles, but their study only provides very detailed guidance for its application in case of TVS [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Radiologists were required to assign a score according to the revised ENZIAN score 2020 [ 15 ] and to compile a structured template following parameters reported below, as is summarized in Figure 1 and Figure 2 :…”

Section: Methodsmentioning

confidence: 99%

“…Hence, the latest revision of the ENZIAN score 2020 proposes a new comprehensive classification system, which includes the anatomical location and the size of all of the different forms of endometriotic lesions, the presence of adhesions, and the degree of involvement of the adjacent organs [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Manganaro

Celli

Dolciami

et al. 2021

IJERPH

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“…On the other hand, DENs and AD are two very slowly evolving entities, but, as previously stressed, nobody is born with stage IV endometriosis [ 36 ]. In other words, in order for DENs to evolve from C1 (≤1 cm) to C3 (≥3 cm) according to the #Enzian classification [ 37 ], we must accept that, at a certain point in time, they possess the capacity to grow and progress [ 36 , 38 ]. Our goal here was to detect similarities between these two gradually developing diseases, hoping to pave the way for more extensive research into their potential common origin.…”

Section: Discussionmentioning

confidence: 99%

Identifying Common Pathogenic Features in Deep Endometriotic Nodules and Uterine Adenomyosis

Stratopoulou

Camboni

Donnez

et al. 2021

JCM

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Increasing imaging data point to a link between deep endometriotic nodules (DENs) and uterine adenomyosis (AD). The study aimed to investigate this link at the histological level and detect potential features shared by the two diseases. We collected formalin-fixed paraffin-embedded tissue (endometrium and lesions) from women with DENs of the rectovaginal septum (n = 13), AD (n = 14), and control subjects (n = 14). Immunohistochemical analyses of CD41 and CD68 were conducted to explore the roles of platelets and macrophages, respectively. Picrosirius red staining was carried out to gather evidence of fibrosis. Vascular endothelial growth factor (VEGF) was assessed, and total numbers of CD31-positive vessels were calculated to investigate the mechanism governing angiogenesis. Double immunohistochemistry for CD31 and alpha smooth muscle actin (αSMA) was performed to discern stable vessels. Platelet aggregation was significantly decreased in both types of lesions compared to their corresponding eutopic endometrium and healthy controls. Macrophage numbers were higher in both lesions than in their corresponding endometrium and healthy subjects. Significantly higher rates of collagen accumulation were detected in DENs and AD lesions compared to their corresponding eutopic and healthy endometrium. VEGF expression was downregulated in the stromal compartment of AD lesions compared to the healthy endometrium. The total number of vessels per area was significantly higher in DENs and AD lesions than in the healthy endometrium. Rates of αSMA-surrounded vessels were decreased in DENs and AD lesions compared to their corresponding eutopic and healthy endometrium. We report common pathogenic mechanisms between DENs and AD, namely excessive macrophage accumulation, fibrosis, and irregular angiogenesis. Our results further support the notion of DENs and AD being linked at the histological level.

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“…ENZIAN and rASRM scores are useful for accurate surgical management planning [90]. The endometriosis fertility index (EFI) classification is the only predictable postoperative pregnancy rate system that allows the orientation towards ART of patients with the most unfavorable postoperative prognosis [91,92].…”

Section: Hysterolaparoscopy-a Therapeutic Challenge In the Management Of Endometriosismentioning

confidence: 99%

Hysterolaparoscopy: A Gold Standard for Diagnosing and Treating Infertility and Benign Uterine Pathology

Varlas

Rhazi

Cloțea

et al. 2021

JCM

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Background: Combined hysteroscopy and laparoscopy is a valuable method for diagnosing and treating infertility and benign uterine pathology. Both procedures are minimally invasive, reliable, and safe, with a low complication rate. Aim: In this review, we expose the efficiency and safety of hysterolaparoscopy in the management of infertility and other benign uterine pathologies. Method: We performed a systematic literature review on several databases: PubMed®/MEDLINE, PMC, Crossref.org, and Web of Science in the last 10 years. Inclusion criteria: Women of reproductive age with primary or secondary infertility and/or benign uterine pathology. Exclusion criteria: pre-puberty, menopause, couple with male infertility. Conclusion: Hysterolaparoscopy is a useful tool to assess infertility and simultaneously diagnose and treat pelvic and uterine lesions.

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The #Enzian classification: A comprehensive non‐invasive and surgical description system for endometriosis

Cited by 139 publications

References 23 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?

Identifying Common Pathogenic Features in Deep Endometriotic Nodules and Uterine Adenomyosis

Hysterolaparoscopy: A Gold Standard for Diagnosing and Treating Infertility and Benign Uterine Pathology

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