VP62.22: Comparison of transvaginal sonography and surgical staging of deep endometriosis using the Enzian classification

Comparison of preoperative staging with transvaginal sonography (TVS) using the Enzian classification and surgical findings in women undergoing surgery for deep endometriosis (DE). Observational study of women undergoing TVS and surgery for DE at a tertiary referral centre for endometriosis. Data of 195 women were analysed. DE lesions in different Enzian compartments (A, B, C, FB) were detected with high sensitivities and specificities using TVS (ranging from 84% to 92% and from 73% to 99%, respectively). Quite good sensitivities and specificities were also seen for the detection of specific severity grades (53%–77% and 68%–94%), despite the greater difficulty of evaluating also the exact severity grade compared to the mere presence of a lesion. In most cases the preoperative, TVS-based predictions of DE lesion sizes according to the Enzian severity grades (1 to 3) were confirmed at surgery. The rate of exact concordances varied depending on the Enzian compartment (A, B, C) and lesion size. The highest rates of concordance were seen in Enzian compartment C (rectum, sigmoid colon), with similar results for compartment A (vagina, rectovaginal septum). The rates of exact concordances were slightly lower for Enzian compartment B (uterosacral ligaments, parametria). In discordant cases, generally an underestimation of endometriotic lesion size by one severity grade was observed compared to surgical findings. Regarding the urinary bladder (Enzian compartment FB), 91% of lesions seen at TVS were confirmed during surgery, as well as 98% of cases without any lesion at TVS. TVS performed presurgically using the Enzian classification provides a valuable estimation of disease localisation and lesion size severity, especially for Enzian compartments A, C and FB.