Derin İnfiltratif Endometriozis Evreleme Sistemi
Synopsis
Endometriozis, uterus dışındaki endometriyum benzeri doku lezyonları ile karakterize, kronik pelvik ağrı ve/veya kısırlık ile ilişkili inflamatuar östrojene bağlı bir hastalıktır. Hastalık genellikle karın boşluğuyla sınırlıdır, ancak nadiren akciğerlerde, beyinde ve hatta göz gibi karın dışı bölgelerde lezyonlar tespit edilmiştir. 1970'lerde, endometriozis için ilk 'sınıflandırma' sistemi, endometriozisin konservatif cerrahi tedavisinin sonuçlarını tanımlamayı ve böylece hastalığın kapsamını ve gebelik oranıyla ilişkisini sınıflandırmayı amaçlayan bir çalışmadan kaynaklanmıştır. 1979 tarihinden bu yana çeşitli amaçlar doğrultusunda çok sayıda evreleme sistemleri tanımlanmıştır. Bunlar arasında; 1979 AFS (American Fertility Society), revize edilmiş AFS (rAFS), revize American Society for Reproductive Medicine (rASRM) başlıcalarıdır. Ultrason temelli Endometriozis evreleme sistemine (UBESS) hastalığın yaygınlığının ameliyat öncesi değerlendirilmesine odaklanmıştır. Bildirilen semptomlara göre en uygun yönetimi seçmeyi amaçlayan, endometriozis için sonuç tahminini özel olarak hedefleyen 'hastalığın kapsamı, şikayetler, hedefler (ECO) sistemi' , ameliyattan sonra doğal gebe kalma olasılığını tahmin etmeyi amaçlayan endometriozis doğurganlık indeksi (EFI) diğer sınıflama sistemlerindendir. Cerrahi hastalık tanımlaması veya evrelemesi için daha sonraki girişimler hastalığın konumuna -üriner sistem endometriozisi veya hastalığın alt tiplerine -derin endometriozis (DE)’ e odaklanmıştır.
Endometriozis, özellikle derin infiltratif endometriozisli kadınların standardize edilerek değerlendirilmesi, cerrahi ve/veya konservatif yönetim yaklaşımlarının planlanması ile birlikte endometriozis tedavisi sunan sağlık tesislerinde bakım standardı olmalıdır.
Endometriosis is an inflammatory estrogen-dependent disease characterized by endometrium-like tissue lesions outside the uterus, associated with chronic pelvic pain and/or infertility. The disease is usually confined to the abdominal cavity, but occasionally lesions have been identified in extra-abdominal areas such as the lungs, brain, and even the eye. In the 1970s, the first 'classification' system for endometriosis arose from a study that aimed to describe the results of conservative surgical treatment of endometriosis and thus classify the extent of the disease and its relationship to pregnancy rate. Since 1979, a number of staging systems have been defined for various purposes. Among these are the 1979 AFS (American Fertility Society), revised AFS (rAFS), and revised American Society for Reproductive Medicine (rASRM). The ultrasound-based Endometriosis staging system (UBESS) focuses on preoperative assessment of the extent of the disease. Other classification systems include the ‘extent of disease, complaints, goals (ECO) system’, which specifically targets outcome prediction for endometriosis, aiming to select the most appropriate management according to the symptoms reported, and the endometriosis fertility index (EFI), which aims to estimate the probability of natural conception after surgery. Subsequent attempts at surgical disease definition or staging have focused on the location of the disease – urinary tract endometriosis or the subtypes of the disease – deep endometriosis (DE).
Standardized assessment of women with endometriosis, especially deep infiltrative endometriosis, should be the standard of care in healthcare facilities that provide endometriosis treatment, along with planning surgical and/or conservative management approaches.
References
Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, Rienzi L, Sunde A, Schmidt L, Cooke ID et al. The international glossary on infertility and fertility care, 2017. Hum Reprod 2017;32:1786–1801.
Working group of ESGE ESHRE and WES Keckstein J, Becker CM, Canis M, Feki A, Grimbizis GF, Hummelshoj L, Nisolle M, Roman H, Saridogan E. Recommendations for the surgical treatment of endometriosis Part 2: deep endometriosis. Facts Views Vis Obgyn 2020a;11:269–297.
Working group of ESGE ESHRE and WES, Keckstein J, Becker CM, Canis M, Feki A, Grimbizis GF, Hummelshoj L, Nisolle M, Roman H, Saridogan E et al. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open 2020b;2020:hoaa002.
Working group of ESGE ESHRE and WES, Saridogan E, Becker CM, Feki A, Grimbizis GF, Hummelshoj L, Keckstein J, Nisolle M, Tanos V, Ulrich UA, Vermeulen N et al. Recommendations for the surgical treatment of endometriosis-part 1: ovarian endometrioma. Gynecol Surg 2017a;14:27.
Working group of ESGE ESHRE and WES, Saridogan E, Becker CM, Feki A, Grimbizis GF, Hummelshoj L, Keckstein J, Nisolle M, Tanos V, Ulrich UA et al. Recommendations for the Surgical Treatment of Endometriosis. Part 1: Ovarian Endometrioma. Hum Reprod Open 2017b;2017:hox016.
Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med 2020;382:1244–1256.
Miller-Keane OTM, O’Toole MT. Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health. Philadelphia, PA, USA: Elsevier Health Sciences, 2005.
Acosta AA, Buttram VC Jr, Besch PK, Malinak LR, Franklin RR, . Vanderheyden JD. A proposed classification of pelvic endometri- . osis. Obstet Gynecol 1973;42:19–25.
Buttram VC Jr. An expanded classification of endometriosis. Fertil Steril 1978;30:240–242.
American Fertility Society. Classification of endometriosis. The . American Fertility Society. Fertil Steril 1979;32:633–634.
American Fertility Society. Revised American Fertility Society classifi- . cation of endometriosis: 1985. Fertil Steril 1985;43:351–352.
American Society for Reproductive Medicine. Revised American . Society for Reproductive Medicine classification of endometriosis: . 1996. Fertil Steril 1997;67:817–821.
Knabben L, Imboden S, Fellmann B, Nirgianakis K, Kuhn A, Mueller . MD. Urinary tract endometriosis in patients with deep infiltrating . endometriosis: prevalence, symptoms, management, and proposal . for a new clinical classification. Fertil Steril 2015;103:147–152.
Chapron C, Dubuisson JB, Chopin N, Foulot H, Jacob S, Vieira M, Barakat H, Fauconnier A. [Deep pelvic endometriosis: manage- ment and proposal for a “surgical classification”]. Gynecol Obstet Fertil2003a;31:197–206.
Tuttlies F, Keckstein J, Ulrich U, Possover M, Schweppe KW, . Wustlich M, Buchweitz O, Greb R, Kandolf O, Mangold R et al. . [ENZIAN-score, a classification of deep infiltrating endometriosis]. . Zentralbl Gynakol 2005;127:275–281.
Coccia ME, Rizzello F. Ultrasonographic staging: a new staging system for deep endometriosis. Ann N Y Acad Sci 2011;1221:61–69.
Keckstein J, Saridogan E, Ulrich UA, Sillem M, Oppelt P, Schweppe . Kw, Krentel H, Janschek E, Exacoustos C, Malzoni M et al. The . #Enzian classification: a comprehensive non-invasive and surgical . description system for endometriosis. Acta Obstet Gynecol Scand . 2021;100:1165–1175.
van der Wat J, Kaplan MD, Roman H, Da Costa C. The use of mod- . ified virtual colonoscopy to structure a descriptive imaging classifi- . cation with implied severity for rectogenital and disseminated . endometriosis. J Minim Invasive Gynecol 2013;20:543–546.
Lafay Pillet MC, Huchon C, Santulli P, Borghese B, Chapron C, . Fauconnier AA. clinical score can predict associated deep infiltrat- . ing endometriosis before surgery for an endometrioma. Hum . Reprod 2014;29:1666–1676.
Menakaya U, Reid S, Lu C, Gerges B, Infante F, Condous G. Performance of ultrasound-based endometriosis staging system (UBESS) for predicting level of complexity of laparoscopic surgery for endometriosis. Ultrasound Obstet Gynecol 2016;48:786–795.
Riiskjær M, Egekvist AG, Hartwell D, Forman A, Seyer-Hansen M, . Kesmodel US. Bowel Endometriosis Syndrome: a new scoring sys- . tem for pelvic organ dysfunction and quality of life. Hum Reprod . 2017;32:1812–1818.
Chattot C, Huchon C, Paternostre A, Du Cheyron J, Chouillard E, Fauconnier A. ENDORECT: a preoperative score to accurately predict rectosigmoid involvement in patients with endometriosis. Hum Reprod Open 2019;2019:hoz007.
Ichikawa M, Akira S, Kaseki H, Watanabe K, Ono S, Takeshita T. . Accuracy and clinical value of an adhesion scoring system: A pre- . operative diagnostic method using transvaginal ultrasonography for . endometriotic adhesion. J Obstet Gynaecol Res 2020;46:466–478.
Lasmar BR, Simoes Abraao M, Lasmar RB, Leon Dewilde R. . Simplified approach to the treatment of endometriosis–ECO sys- . tem. Minerva Ginecol 2012;64:331–335.
Lasmar RB, Lasmar BP, Celeste RK, Larbig A, De Wilde RL. Validation of a score to guide endometriosis therapy for the non- specialized gynecologist. Int J Gynaecol Obstet 2015;131:78–81.
Adamson GD, Pasta DJ. Endometriosis fertility index: the new, . validated endometriosis staging system. Fertil Steril 2010;94: . 1609–1615.
Bouquet de Joliniere J, Major A, Ayoubi JM, Cabry R, Khomsi F, Lesec G, Frydman R, Feki A. It is necessary to purpose an add-on to the American Classification of Endometriosis? This disease can be compared to a malignant proliferation while remaining benign in most cases. EndoGramVR is a new profile witness of its evolutionary potential. Front Surg 2019;6:27.
Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FP, Van Schoubroeck D, Exacoustos C, Installe AJ, Martins WP, Abrao MS, Hudelist G, Bazot M, Alcazar JL, Goncalves MO, Pascual MA, Ajossa S, Savelli L, Dunham R, Reid S, Menakaya U, Bourne T, Ferrero S, Leon M, Bignardi T, Holland T, Jurkovic D, Benacerraf B, Osuga Y, Somigliana E, Timmerman D. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol 2016; 48: 318 – 332.
Leonardi M, Uzuner C, Mestdagh W, Lu C, Guerriero S, Zajicek M, Dueckelmann A, Filippi F, Buonomo F, Pascual MA, Stepniewska A, Ceccaroni M, Van den Bosch T, Timmerman D, Hudelist G, Condous G. Diagnostic accuracy of transvaginal ultrasound for detection of endometriosis using International Deep Endometriosis Analysis (IDEA) approach: prospective international pilot study. Ultrasound Obstet Gynecol 2022; 60: 404 – 413.
Szabo G, Hudelist G, Madar I, Rigo JJ, Dobo N, Fintha A, Liptak L, Kalovics E, Fancsovits V, Bokor A. Diagnostic accuracy of the IDEA protocol for non invasive diagnosis of rectosigmoid DE - a prospective cohort study. Ultraschall Med 2024; 45: 61 – 68.
Leonardi M, Espada M, Choi S, Chou D, Chang T, Smith C, Rowan K, Condous G. Transvaginal Ultrasound Can Accurately Predict the American Society of Reproductive Medicine Stage of Endometriosis Assigned at Laparoscopy. J Minim Invasive Gynecol 2020; 27: 1581 – 1587.e1.
Chaabane S, Nguyen Xuan HT, Paternostre A, Du Cheyron J, Harizi R, Mimouni M, Fauconnier A. [Endometriosis: Assessment of the Ultrasound-Based Endometriosis Staging System score (UBESS) in predicting surgical difficulty]. Gynecol Obstet Fertil Senol 2019; 47: 265 – 272.
Espada M, Leonardi M, Aas-Eng K, Lu C, Reyftmann L, Tetstall E, Slusarczyk B, Ludlow J, Hudelist G, Reid S, Condous G. A Multicenter International Temporal and External Validation Study of the Ultrasound-based Endometriosis Staging System. J Minim Invasive Gynecol 2021; 28: 57 – 62.
International working group of AAGL, ESGE, ESHRE and WES; Vermeulen N, Abrao MS, Einarsson JI, Horne AW, Johnson NP, Lee Ttm, Missmer S, Petrozza J, Tomassetti C, Zondervan KT, Grimbizis G, De Wilde RL. Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification. Hum Reprod Open 2021; 2021: hoab025.
Abrao MS, Andres MP, Miller CE, Gingold JA, Rius M, Neto JS, Carmona F. AAGL 2021 Endometriosis Classification: An Anatomy-based Surgical Complexity Score. J Minim Invasive Gynecol 2021; 28: 1941 – 1950.e1.
Abrao MS, Andres MP, Gingold JA, Rius M, Neto JS, Goncalves MO, Giovanni AD, Malzoni M, Carmona F. Preoperative Ultrasound Scoring of Endometriosis by AAGL 2021 Endometriosis Classification Is Concordant with Laparoscopic Surgical Findings and Distinguishes Early from Advanced Stages. J Minim Invasive Gynecol 2023; 30: 363 – 373.
Tomassetti C, Bafort C, Vanhie A, Meuleman C, Fieuws S, Welkenhuysen M, Timmerman D, Van Schoubroeck D, D’Hooghe T. Estimation of the Endometriosis Fertility Index prior to operative laparoscopy. Hum Reprod 2021; 36: 636 – 646.
Montanari E, Bokor A, Szabo G, Kondo W, Trippia CH, Malzoni M, Di Giovanni A, Tinneberg HR, Oberstein A, Rocha RM, Leonardi M, Condous G, Alsalem H, Keckstein J, Hudelist G. Comparison of #Enzian classification and revised American Society for Reproductive Medicine stages for the description of disease extent in women with deep endometriosis. Hum Reprod 2022; 37: 2359 – 2365.
Di Giovanni A, Montanari E, Hudelist G, Malzoni M, Keckstein J. Comparison Between Sonography-Based and Surgical Evaluation of Endometriotic Lesions Using the #Enzian Classification - A Retrospective Data Analysis. Ultraschall Med 2023; 44: 290 – 298.
Bindra V, Madhavi N, Mohanty GS, Nivya K, Balakrishna N. 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 2023; 307: 179 – 186.
Montanari E, Bokor A, Szabo G, Kondo W, Trippia CH, Malzoni M, Di Giovanni A, Tinneberg HR, Oberstein A, Rocha RM, Leonardi M, Condous G, Alsalem H, Keckstein J, Hudelist G. Accuracy of sonography for non-invasive detection of ovarian and deep endometriosis using #Enzian classification: prospective multicenter diagnostic accuracy study. Ultrasound Obstet Gynecol 2022; 59: 385 – 391.
Timmerman D, Valentin L, Bourne TH, et al. Terms, defini- tions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000;16:500-505.
Koninckx PR, Martin DC. Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril. 1992;58:924-928.
Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected en- dometriosis, including terms, definitions and measurements: a con- sensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48:318-332.
Carfagna P, De Cicco Nardone C, De Cicco Nardone A, et al. Role of transvaginal ultrasound in evaluation of ureteral involvement in deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2018;51:550-555.
Pateman K, Mavrelos D, Hoo WL, Holland T, Naftalin J, Jurkovic D. Visualization of ureters on standard gynecological transvaginal scan: a feasibility study. Ultrasound Obstet Gynecol. 2013;41:696-701.
