Staging of pelvic endometriosis based on MRI findings versus laparoscopic classification according to the American Fertility Society

R Zanardi, Romeo Zanardi, C Del Frate, Chiara Del Frate, C Zuiani, Chiara Zuiani, Massimo Bazzocchi, M Bazzocchi
Abdominal imaging · 2003 · vol. 28(5) , pp. 733–742 · doi:10.1007/s00261-003-0005-2 · PMID:14628887 · W2060405678
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Magnetic resonance imaging (MRI) demonstrated high concordance with the American Fertility Society (AFS) laparoscopic classification for staging pelvic endometriosis.

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This study evaluated whether MRI-based staging of pelvic endometriosis could match American Fertility Society (AFS) laparoscopic classification. Forty-four women with clinically suspected endometriosis underwent pelvic MRI to detect endometriomas and pelvic implants, followed by laparoscopy within two weeks; the authors developed an MRI scoring system into four classes comparable to AFS. Laparoscopy confirmed most MRI-detected endometriomas, and implant detection was incomplete by MRI, but overall staging concordance was very high, with 42 of 44 patients concordant and κ = 0.913. The paper explicitly notes MRI limitations in depicting small implants and adhesions, yet reports that MRI is useful for preoperative staging based on the high concordance. This paper is centrally about endometriosis—specifically comparing MRI-based staging against AFS laparoscopic staging for pelvic endometriosis.

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Abstract

Background: Preoperative staging of pelvic endometriosis helps the gynecologist plan therapy and offers a prognosis to patients. We compared a staging system of pelvic endometriosis based on magnetic resonance imaging (MRI) findings with the American Fertility Society (AFS) laparoscopic classification.

Methods

Forty-four consecutive females with clinically suspected endometriosis underwent MRI examination to demonstrate the presence of endometriomas and pelvic implants. Laparoscopy was performed within 2 weeks. An MRI score was developed to classify endometriosis into four classes comparable to those of AFS laparoscopic staging. Concordance between MRI and laparoscopic classification was evaluated with κ statistics.

Results

Laparoscopy confirmed 60 of 61 endometriomas detected by MRI. Implants were discovered in 20 of 44 patients with MRI and in 23 of 44 with laparoscopy. MRI detected 50 endometrial implants of 65 detected by laparoscopy (76.9%). With regard to endometriosis staging, we obtained a concordance between MRI and AFS classification in 42 of 44 patients (κ = 0.913).

Conclusion

Although MRI has limitations such as suboptimal depiction of small implants and adhesions, this technique is very useful to guide laparoscopy. Moreover, the optimal concordance (95%) between our proposed MRI staging and the AFS laparoscopic classification demonstrated a new advantage of MRI in preoperative staging of endometriosis. Similar content being viewed by others Author information Authors and Affiliations Rights and permissions About this article Cite this article Zanardi, ., Del Frate, ., Zuiani, . et al. Staging of pelvic endometriosis based on MRI findings versus laparoscopic classification according to the American Fertility Society. Abdom Imaging 28, 733–742 (2003). https://doi.org/10.1007/s00261-003-0005-2 Issue date: DOI: https://doi.org/10.1007/s00261-003-0005-2

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Magnetic Resonance Imaging Adult Diagnosis, Differential Endometriosis Endometriosis Female Humans Laparoscopy

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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