Value of ultrasound-based endometriosis staging system in anticipating complexity of laparoscopic surgery

Ebrahimi M, Mahbod Ebrahimi, Naghdi S, Soofia Naghdi, Sholeh Naghdi, Fatemeh Davari-Tanha, Davari-Tanha F, Fatemeh Davari Tanha, Behnaz Moradi, Moradi B, Elham Feizabad, Feizabad E, Kiana Majidi, Majidi K
Fertility and sterility · 2024 · vol. 123(5) , pp. 893–898 · doi:10.1016/j.fertnstert.2024.11.018 · PMID:39577829 · W4404566090
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This study evaluated the ability of an ultrasound-based staging system to predict the complexity of laparoscopic surgery for endometriosis.

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Abstract

OBJECTIVE: To evaluate the effectiveness of the preoperative ultrasound-based endometriosis staging system (UBESS) in anticipating the complexity of laparoscopic surgery for optimal patient counseling and treatment. DESIGN: A prospective observational cohort study. SUBJECTS: A total of 157 women presenting with chronic pelvic pain and/or a history of endometriosis underwent laparoscopic surgery between June 2019 and May 2023. EXPOSURE: Eligible women underwent transvaginal ultrasound before laparoscopic surgery. MAIN OUTCOME MEASURES: The UBESS staging was conducted based on ultrasound results. Subsequently, the necessary surgical skill levels were assessed, during the laparoscopic procedure, using the Royal Australian and New Zealand College of Obstetricians and Gynecologists/Australasian Gynecological Endoscopy and Surgery (RANZCOG/AGES) system. The study aimed to evaluate the correlation between the three UBESS stages and the six RANZCOG/AGES laparoscopic skill levels. The primary objective was how accurately the UBESS predicts the complexity of endometriosis laparoscopic surgery. RESULTS: The UBESS staging system classified nine patients (5.9%) as UBESS I, 61 patients (40.1%) as UBESS II, and 82 patients (53.9%) as UBESS III. The accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of the UBESS I for anticipating RANZCOG/AGES levels 1/2 were: 99.3%, 90%, 100%, 100%, 99.3%, not applicable, and 0.1%. For UBESS II to anticipate RANZCOG/AGES levels 3/4 were 96.7%, 95.1%, 97.7%, 96.7%, 96.7%, 0.92, and 0.04, and for UBESS III to anticipate RANZCOG/AGES level 6 were 97.3%, 98.7%, 95.8%, 96.3%, 98.5%, 0.94, and 0.01, respectively. Ultrasound-based endometriosis staging system was highly accurate in anticipating the complexity of laparoscopic surgery based on RANZCOG/AGES laparoscopic skill levels, with an overall accuracy of 96.7% and a Cohen's kappa value of 0.94, which implies an approximately complete level of agreement. Considering the significant number of UBESS II and UBESS III patients and their high accuracy, sensitivity, and specificity, this staging system is an effective tool for predicting moderate-to-severe endometriosis. CONCLUSION: The study indicated that UBESS could serve as an efficient, noninvasive, accessible, and cost-effective tool for estimating the severity of endometriosis and predicting the complexity level of laparoscopic surgery based on the RANZCOG/AGES surgical skill levels.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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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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