Reproducibility of #Enzian classification by transvaginal ultrasound and its correlation with symptoms

Consuelo Russo, C Russo, Lucia Lazzeri, L Lazzeri, T Siciliano, A Selntigia, D Farsetti, C Chiaramonte, Carlo Chiaramonte, F G Martire, Francesco Giuseppe Martire, Errico Zupi, E Zupi, C Exacoustos, C. Exacoustós
Facts, views & vision in ObGyn · 2024 · vol. 16(1) , pp. 47–58 · doi:10.52054/fvvo.16.1.008 · PMID:38551474 · W4393953414
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study found the #Enzian classification reproducible for transvaginal ultrasound assessment of endometriosis, with dyspareunia and bowel symptoms correlating with compartment B, and HMB correlating with FA.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

The study evaluated interobserver reproducibility of transvaginal ultrasound (TVS) use of the #Enzian classification and assessed how specific #Enzian compartments relate to symptoms in patients with pelvic endometriosis. Two experienced operators performed TVS in 52 patients, and a separate set of 200 women with ultrasound signs of endometriosis (no prior surgery and no hormonal therapy) were staged by one of three operators; agreement was quantified and compartments (A, B, C, O, T, FA, FB, FI, FU, FO) were analyzed alone and in combinations against symptoms including dysmenorrhea, dyspareunia, heavy menstrual bleeding, and bowel symptoms. Excellent agreement was found between the two operators for almost all compartments (k>0.8), dysmenorrhea showed no compartment-specific correlation, and dyspareunia correlated with the B compartment while heavy menstrual bleeding correlated with FA and bowel symptoms correlated with B. This paper is centrally about endometriosis — it studies reproducibility of #Enzian ultrasound compartment staging and links symptom patterns to specific lesion compartments.

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Abstract

Background: The #Enzian classification represents a system to describe endometriotic lesions during surgery. Its use is well established in correlating ultrasound and surgical findings. Objectives: To describe interobserver reproducibility of ultrasound use and symptom correlation with compartments involved using #Enzian classification. Materials and Methods: Two experienced operators performed transvaginal sonography (TVS) in 52 patients affected by pelvic endometriosis. A rate agreement was determined. A further 200 women with endometriotic TVS signs, with no previous surgery and not taking any hormonal therapy, were staged by one of three different operators according to the #Enzian (compartments A, B, C, O, T, FA, FB, FI, FU, FO). Statistical analysis compared all the compartments, as single or associated, with single or combined symptoms (dysmenorrhea, dyspareunia, heavy menstrual bleeding - HMB, bowel symptoms). Main outcome measures: Evaluation of the reproducibility of #Enzian classification in assessing pelvic endometriosis among different operators using TVS, and of possible associations between symptoms and specific #Enzian compartments. Results: Excellent agreement between the two operators in evaluating almost all the compartments (k >0.8) was observed. Dysmenorrhea did not correlate with any specific compartment. We observed a significant association between dyspareunia and B compartment (p=0.02). HMB is associated with FA (p=0.02). Bowel symptoms were associated with B (p=0.02). Combining more symptoms, we observed more significant associations with different compartments. Conclusions: #ENZIAN classification is reproducible in the evaluation of pelvic endometriosis. Some symptoms are correlated to specific ultrasound signs of the disease. What is new?: An accurate evaluation of symptoms could guide TVS examination to detect specific endometriotic lesions and establish the best management for the patients.
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Background

The #Enzian classification represents a system to describe endometriotic lesions during surgery. Its use is well established in correlating ultrasound and surgical findings.

Objectives

To describe interobserver reproducibility of ultrasound use and symptom correlation with compartments involved using #Enzian classification.

Materials and methods

Two experienced operators performed transvaginal sonography (TVS) in 52 patients affected by pelvic endometriosis. A rate agreement was determined. A further 200 women with endometriotic TVS signs, with no previous surgery and not taking any hormonal therapy, were staged by one of three different operators according to the #Enzian (compartments A, B, C, O, T, FA, FB, FI, FU, FO). Statistical analysis compared all the compartments, as single or associated, with single or combined symptoms (dysmenorrhea, dyspareunia, heavy menstrual bleeding - HMB, bowel symptoms). Main outcome measures: Evaluation of the reproducibility of #Enzian classification in assessing pelvic endometriosis among different operators using TVS, and of possible associations between symptoms and specific #Enzian compartments.

Results

Excellent agreement between the two operators in evaluating almost all the compartments (k >0.8) was observed. Dysmenorrhea did not correlate with any specific compartment. We observed a significant association between dyspareunia and B compartment (p=0.02). HMB is associated with FA (p=0.02). Bowel symptoms were associated with B (p=0.02). Combining more symptoms, we observed more significant associations with different compartments.

Conclusions

#ENZIAN classification is reproducible in the evaluation of pelvic endometriosis. Some symptoms are correlated to specific ultrasound signs of the disease.

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Outcome instruments

VAS-pain rASRM Enzian

Condition tags

endometriosisdysmenorrheadyspareunia

Citation neighborhood (2-hop)

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. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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