Preoperative Ultrasound Scoring of Endometriosis by AAGL 2021 Endometriosis Classification Is Concordant with Laparoscopic Surgical Findings and Distinguishes Early from Advanced Stages

Elsevier

Available online 18 November 2022

Journal of Minimally Invasive GynecologyAuthor links open overlay panelAbstractStudy Objective

: To compare the accuracy of pre-operative ultrasound in predicting the laparoscopically defined 2021 AAGL Endometriosis Staging.

Setting

: Three specialized endometriosis surgical centers in São Paulo (Brazil), Barcelona (Spain), and Avellino (Italy) participated.

Design

: Retrospective multicenter study of patients treated at 3 specialized endometriosis centers.

Patients

: 878 patients aged 15-45 years with no history of pelvic malignancy underwent laparoscopic treatment for suspected endometriosis.

Interventions

: Retrospective review of preoperative transvaginal and transabdominal ultrasound (index test) assessed for endometriosis at all sites used in the 2021 AAGL Endometriosis Classification and classified patients into AAGL-ultrasound (AAGL-US) stages 1-4. Results were compared to reference-standard laparoscopic (AAGL-LPS) staging.

Measurements and Main Results

: The AAGL-US and AAGL-LPS stage were concordant in 586 (66.7%) cases [weighted kappa (WK) 0.759; intraclass correlation = 0.906), with the highest agreement observed in patients with no endometriosis (n=70, 75.3% concordance), AAGL-LPS Stage 1 (104, 50.7%) and Stage 4 disease (358, 88.2%). Endometriosis was most accurately diagnosed in the rectum/sigmoid colon (WK 0.862), bladder (WK 0.911) and ovaries (WK 0.835/0.795 for right/left, respectively), and least accurately diagnosed at superficial peritoneal (WK 0.442), tubal (WK 0.391/0.363 for right/left, respectively) and retrocervical/uterosacral ligament (WK 0.656) sites.

Conclusion

: Sonographic estimation of the 2021 AAGL Endometriosis staging is greatest in AAGL-LPS stages 1 and 4 as well as among patients with no endometriosis. Ultrasound best identifies endometriosis of the ovaries, bladder, and bowel but is more limited for the tubes and superficial peritoneum.

Keywords

Endometriosis

Staging

Ultrasound

Laparoscopy

Infertility

Pelvic pain

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