P10.05: Integrated Enzian classification: a new proposal for sonographic pelvic endometriosis staging – feasibility and interobserver reproducibility

To determine the ultrasound feasibility and the interobserver reproducibility of a new classification of pelvic endometriosis based on an integration of the Enzian classification. 52 women with ultrasound features of endometriosis were enrolled. The study was conducted from January to February 2019. Two operators, blinded and independently, performed an ultrasound and assessed disease severity with the new Integrated Enzian classification (IEC), based on the Enzian classification with an addition of other compartments. The three pelvic compartments of the Enzian classification include: rectovaginal space and vagina (A), uterosacral and cardinal ligaments, pelvic sidewall (B), recto-sigmoid (C). IEC adds the evaluation of adhesions (D), ovaries (E), bladder (FB), adenomyosis (FA). All compartments were graded in three levels. A numerical score graded the total amount of disease. Rate agreement and reproducibility between the operators were calculated. Multiple rate agreements to classify endometriosis through IEC ranged from substantial to almost perfect (Cohen k 0.658 – 1). A lower agreement rate, albeit substantial (Cohen k > 0.65), was detected for A, B, FA and D. The lower agreement in the evaluation of adhesions (D) was due to absence of adhesions in some patients. The lowest agreement, albeit substantial (Cohen k 0.658), was observed for the compartment level A3 (large vaginal or recto-vaginal-septal lesions). Agreement for small nodules (level 1) in compartments A, C and FB seemed to be lower than in other levels. The agreement rate for the total score levels, a reflection of the total extension of the disease, ranged from substantial to perfect. IEC is reproducible and easy to use during ultrasound evaluation of pelvic endometriosis. The standardisation of the diagnosis and extension of pelvic disease represents is crucial for the correct management and surgical approach. IEC is designed as diagnostic tool and as a surgical classification as well. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.