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Pre-operative mapping and structured reporting of pelvic endometriotic lesions on dynamic ultrasound and its correlation on laparoscopy using the #ENZIAN classification

  • General Gynecology
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Abstract

Purpose

The objective of this study was to evaluate and compare the diagnostic performance of ultrasonography (USG) assessment using structured reporting with intraoperative laparoscopic assessment in deep infiltrating endometriosis (DIE) using the recent update of the #ENZIAN classification.

Methods

This was a retrospective study conducted in Tertiary Multi-disciplinary Endometriosis Care Hospital over a period of 8 months which included 50 patients who underwent a planned laparoscopic endometriosis excisional surgery after a dedicated USG assessment using International Deep Endometriosis Analysis (IDEA) protocol and #ENZIAN score (updated ENZIAN classification), between Feb 2021 and Sept 2021 at Apollo Hospitals, Hyderabad. The pre-operative USG findings were reported in a structured reporting format and intraoperative findings were classified using the standard #ENZIAN classification. No prospective interventions were done. A review of pre-operative ultrasound and laparoscopic findings as per the #ENZIAN was done.

Results

Sensitivity and the negative predictive value of ultrasound were 86% and 84.2% for peritoneal lesions, 97% and 93.3% for left ovarian lesions, 93% and 91.6% for right ovarian lesions, 91% and 84% for left tubal lesions, 90% and 86.3% for right tubal lesions, 93% and 75% for uterosacral ligaments, 93.3% and 97% for rectal lesions and sensitivity and negative predictive values were 100% for rectovaginal lesions, adenomyosis, and ureteric lesions as confirmed on laparoscopy.

Conclusion

Dynamic ultrasound assessment with a structured report based on IDEA protocol and #ENZIAN score is accurate for mapping of pelvic endometriosis in all forms, and it correlates with laparoscopic findings, thus helps surgeon for better planning and providing a road map for surgeons. From a clinical perspective, a uniform and shared reporting system across imaging and therapeutic modalities will simplify communication, improving patient management by conservative or surgical treatments, avoiding multiple repeat surgeries, and improving quality of treatment.

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Acknowledgements

We would like to thank Prof Jorg Keckstein for his guidance and inputs in this study and granting permission to reproduce #ENZIAN Classification. Thanks to all our patients whom we could include for our study.

Funding

The authors declare that no funds, Grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Apollo Hospital, Hyderabad, India

    Vimee Bindra

  2. Madhavi Scan Centre, Hyderabad, India

    Nori Madhavi

  3. Department of OBG, Apollo Hospital, Hyderabad, India

    Girija Shankar Mohanty & K. Nivya

  4. Department of the Statistics, Apollo Institute of Medical Sciences and Research, Hyderabad, India

    N. Balakrishna

Authors
  1. Vimee Bindra
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  2. Nori Madhavi
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  3. Girija Shankar Mohanty
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  4. K. Nivya
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  5. N. Balakrishna
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection was performed by VB, NM, GSM, KN. Statistical analysis and interpretation of results was performed by NB. The first draft of the manuscript was written by VB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vimee Bindra.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Committee—Biomedical Research, Apollo Hospitals, Hyderabad (Dated 23rd October 2021; Application No. AHJ-ACD-079/10-21).

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Bindra, V., Madhavi, N., Mohanty, G.S. et al. Pre-operative mapping and structured reporting of pelvic endometriotic lesions on dynamic ultrasound and its correlation on laparoscopy using the #ENZIAN classification. Arch Gynecol Obstet 307, 179–186 (2023). https://doi.org/10.1007/s00404-022-06494-4

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  • DOI: https://doi.org/10.1007/s00404-022-06494-4

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