Preoperative application of the Enzian classification for endometriosis (The cEnzian Study): A prospective international multicenter study

Simon‐Hermann Enzelsberger, Peter Oppelt, Konstantinos Nirgianakis, Beata Seeber, Jan Drahoňovský, Leopold Wanderer, Bernhard Krämer, Kristin Nannette Grübling, Sudip Kundu, Darius Salehin, Maciej Mierzwinski, Harald Krentel, Philipp Hermann, Helga Wagner, Omar Shebl, Sebastian Daniel Schäfer, Sebastian Schäfer
BJOG: An International Journal of Obstetrics & Gynaecology · 2022 · vol. 129(12) , pp. 2052–2061 · doi:10.1111/1471-0528.17235 · PMID:35596694 · PMC9796328 · W4281257330
article OA: gold CC0 ⤵ 21 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study assessed the preoperative Enzian classification's diagnostic performance for endometriosis, finding poor overall consistency but high specificities and negative predictive values, especially for category 3 lesions.

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Abstract

OBJECTIVE: To assess the diagnostic performance of preoperative application of the Enzian classification (cEnzian) using surgical findings as reference standard. DESIGN: A prospective international non-interventional study. SETTING: Twelve endometriosis centres in four European countries (Austria, Germany, Switzerland and Czech Republic). POPULATION: 1062 women with endometriosis surgery. METHODS: Extent of endometriosis was preoperatively classified using the cEnzian classification based on gynaecological examination and/or transvaginal ultrasound (TVS) and/or magnetic resonance imaging (MRI). After subsequent surgery, the surgeon classified the intraoperative findings using the Enzian classification. MAIN OUTCOME MEASURES: and accuracy were calculated. Conditional frequencies of intraoperative Enzian codings and the corresponding 95% confidence intervals were computed for each preoperative coding and visualised in plots. RESULTS: Although overall consistency of cEnzian and Enzian was poor (35.14%, 95% confidence interval 32.26-38.03), high specificities and negative predictive values (NPVs) of the cEnzian compartments could be demonstrated. Looking at the individual parts of the Enzian classification, the poorest diagnostic performance was detected for compartment B and the highest PPVs were found for category 3 lesions (>3 cm), independent of the compartment. CONCLUSIONS: Using the Enzian classification in a non-invasive setting is a useful tool providing us with an 'at a glance' summary of the diagnostic workup regarding deep endometriosis with high specificities and NPVs. An attempt to merge the two new endometriosis classification systems (#Enzian and AAGL 2021) seems reasonable taking into consideration the respective advantages of each other.

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Outcome instruments

Enzian

Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Austria Austria Austria Austria Austria Austria Austria Austria Female Female

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