Are we better off using multiple endometriosis classifications in imaging and surgery than settle for one universal less than perfect protocol? Review of staging systems in ultrasound, magnetic resonance and surgery

Tereza Indrielle-Kelly, Michael Fanta, F. Frühauf, Filip Frühauf, Andrea Burgetová, David Cibula, D. Fischerová
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology · 2021 · vol. 42(1) , pp. 10–16 · doi:10.1080/01443615.2021.1887111 · PMID:34009105 · W3162734791
review OA: closed CC0 ⤵ 8 in-corpus citations
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This review analyzes endometriosis classification systems for ultrasound, MRI, and surgery, highlighting a lack of consensus on disease extent and prognostic features.

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Abstract

There are multiple classifications in imaging and surgery of endometriosis and in this article, we offer a review of the main evaluation systems. The International Deep Endometriosis Analysis group consensus is the leading document for ultrasound assessment, while magnetic resonance imaging is guided by the European Society for Urogenital Radiology recommendations on technical protocol. In surgery, the revised American Society for Reproductive Medicine classification is the oldest system, ideally combined with newer classifications, such as Enzian or Endometriosis Fertility Index. Recently, The World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project introduced detailed proforma for clinical and intraoperative findings. There is still no universal consensus, so the initial emphasis should be on the uniform reporting of the disease extent until research clarifies more the correlations between extent, symptoms and progression in order to develop a reliable staging system.Impact StatementWhat is already known on this subject? There have been several reviews of surgical classifications, comparing their scope and practical use, while in the imaging the attempts for literature review has been scarce.What do the results of this study add? This is the first up to date review offering detailed analysis of the main classification systems across the three main areas involved in endometriosis care - ultrasound, MRI and surgery. The mutual awareness of the radiological classifications for surgeons and vice versa is crucial in an efficient multidisciplinary communication and patient care. On these comparisons we were able to demonstrate the lack of consensus in description of the extent of the disease and even further lack of prognostic features (with the exemption of one surgical system).What are the implications of these findings for clinical practice and/or further research? Future attempts of scientific societies should focus on defining uniform nomenclature for extent description. In the second step the staging classification should encompass prognostic value (risk of disease and symptoms recurrence).

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Outcome instruments

Enzian

Condition tags

mesh:D004715endometriosis

MeSH descriptors

Endometriosis Gynecologic Surgical Procedures Magnetic Resonance Imaging Symptom Assessment Ultrasonography Consensus Endometriosis Female Gynecology Gynecology Humans Severity of Illness Index Societies, Medical Symptom Assessment Symptom Assessment

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.

References (18)

Cited by (8)

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