Comparison Between Sonography-Based and Surgical Evaluation of Endometriotic Lesions Using the #Enzian Classification – A Retrospective Data Analysis

Abstract

Purpose To compare the location and sizes of deep endometriosis (DE) lesions evaluated by preoperative transvaginal sonography (TVS) in different #Enzian compartments with intraoperatively assessed DE location and size.

Materials and Methods Retrospective data analysis of 93 women undergoing TVS and surgery for DE in 2019 at a tertiary referral center for endometriosis.

Results #Enzian compartment C (rectum) showed the highest rate of exact concordance with 74% of cases, which increased to 87% when a tolerance margin of a maximum of 3mm for TVS measurements was taken into account. For compartment B (uterosacral ligaments, parametria) and compartment A (vagina, rectovaginal space), the rates of exact concordance were slightly lower. In compartment O (ovary), high exact concordance rates similar to those observed for compartment C were observed. In compartment T (tubo-ovarian unit), most reliable estimations were seen for slight (TVS T1) and severe adhesions (TVS T3). There were only a few cases of missed lesions as well as false positives on TVS: Sensitivity was 100% for all compartments except for A and B left (97%) and FB (urinary bladder, 86%); specificity was 100% for FB, FI (other intestinal locations), FU (ureters) and O right, 86%-98% for A, B right, C, O left and FO (other extragenital lesions) and 70% for B left.

Conclusion The preoperative evaluation of the location and size of DE lesions by TVS in different #Enzian compartments is accurate, providing a detailed presurgical description of the extent of ovarian and deep endometriosis and associated minor or severe adhesions.

Zusammenfassung

Ziel Vergleich der Evaluierung mittels transvaginalem Ultraschall (TVUS) von Lokalisation und Größe tief infiltrierender Endometriose (TIE)-Läsionen mit der intraoperativen Evaluierung in verschiedenen #Enzian Kompartimenten.

Material und Methoden Retrospektive Datenanalyse von 93 Frauen, die sich im Jahr 2019 in einem tertiären Endometriosezentrum nach TVUS einer chirurgischen TIE-Sanierung unterzogen.

Ergebnisse #Enzian Kompartiment C (Rektum) zeigte die höchste Rate exakter Übereinstimmungen mit 74% der Fälle. Bei Berücksichtigung eines Toleranzbereichs für die TVUS-Messungen von max. 3mm stieg diese auf 87%. Für Kompartiment B (Uterosakral-ligamente, Parametrien) und Kompartiment A (Vagina, Septum rectovaginale) waren die Raten an exakten Übereinstimmungen etwas geringer. In Kompartiment O (Ovar) wurden hohe exakte Übereinstimmungsraten ähnlich wie Kompartiment C beobachtet. In Kompartiment T (tubo-ovarielle Einheit) zeigten sich die verlässlichsten Schätzungen für leichte (TVUS T1) und schwere Adhäsionen (TVUS T3). Es gab nur wenige Fälle übersehener Läsionen sowie falsch positiver Befunde: Die Sensitivität war für alle Kompartimente 100%, außer für A, B links (je 97%) und FB (Harnblase, 86%); die Spezifität war 100% für FB, FI (andere intestinale Lokalisationen), FU (Ureteren) und O rechts, 86%-98% für A, B rechts, C, O links und FO (andere extragenitale Läsionen) und 70% für B links.

Schlussfolgerung Die präoperative Evaluierung von Lokalisation und Größe von TIE Läsionen mittels TVUS in verschiedenen #Enzian Kompartimenten ist akkurat und bietet eine detaillierte Beschreibung des Ausmaßes ovarieller und TIE sowie assoziierter leichter oder schwerer Adhäsionen.

Keywords

lesion size - preoperative evaluation - #Enzian classification - transvaginal sonography (TVS) - THEMES - surgery

Publication History

Received: 03 July 2021

Accepted after revision: 26 November 2021

Article published online:
28 March 2022

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