Objectives

To compare the preoperative detection of endometriosis via transvaginal sonography (TVS) supplemented by transabdominal sonography (TAS) with the surgical assessment of disease using the #Enzian classification for endometriosis.

Methods

Prospective multicentre diagnostic accuracy study including 745 women undergoing TVS/TAS and radical surgery for deep endometriosis (DE) at different tertiary referral centres.

Results

745 women were included in the analysis. Preoperative TVS and surgical findings showed concordance rates between 86% and 99% for the presence or absence of endometriotic lesions depending on the evaluated #Enzian compartment (O – ovaries, T – tubo-ovarian unit, A – vagina/ rectovaginal septum, B – uterosacral ligaments/ cardinal ligaments/ pelvic sidewalls, C – rectum), with concordance rates between TVS/TAS and surgery ranging between 71-92% for different severity grades, i.e., sizes reflected by #Enzian grades 1-3. It was most difficult to determine the presence or absence of adhesions at the level of the tubo-ovarian unit and to exactly classify them as mild (T1), moderate (T2) or severe (T3). The sensitivities for the detection of endometriotic lesions ranged from 50% (#Enzian compartment FI – other intestinal locations) to 95% (#Enzian A), specificities from 86% (#Enzian T left) to 99% (#Enzian FI) and 100% (#Enzian FB – urinary bladder, FU – ureters and FO – other extragenital locations) with positive predictive values of 90% (#Enzian T right) to 100% (#Enzian FO), negative predictive values of 74% (#Enzian B left) to 99% (#Enzian FB and FU) and accuracies of 88% (#Enzian B right) to 99% (#Enzian FB).

Conclusions

Location and severity of endometriotic lesions as described and classified by the #Enzian classification can be accurately diagnosed non-invasively with TVS/TAS. The #Enzian classification provides a uniform classification system for describing endometriotic lesions which can be used with TVS/TAS and for surgical purposes.

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