Roberts Carla P, Rock John A
Department of Gynecology and Obstetrics, Emory University, 1639 Pierce Drive, WMB Room 4208, Atlanta, GA 30322, USA.
Obstet Gynecol Clin North Am. 2003 Mar;30(1):115-32. doi: 10.1016/s0889-8545(02)00056-6.
A multicenter collaboration for data collection and statistical analysis may be necessary to establish and validate a classification system based on empirically derived scores for specific pathologic observations. The endometriosis pain instrument may be a tool for some of those variables with regard to pelvic pain. A similar strategy for uniform collection of data for analysis of important factors also is necessary for infertility. The challenge of creating a satisfactory classification of endometriosis remains. The ability of the current classification schemes to predict pregnancy outcome or aid in the management of pelvic pain is recognized to be inadequate. Further revisions of the current classification scheme are anticipated as the understanding of how endometriosis contributes to infertility and pelvic pain evolves. In any revision of the classification system, use of empirically derived weights and breakpoints to define disease stages based on outcome data in larger clinical trials should be attempted. It is also possible that additional factors, such as CA-125 level or lesion characteristics, may be shown to play an important role in prognosis. If so, these must be accounted for in the classification scheme. Careful and consistent use of the recommendations of the American Society for Reproductive Medicine classification of endometriosis subcommittee should allow for collection of data for use in further revisions. It is possible that a classification scheme that is designed to predict outcome with respect to pregnancy may be totally inadequate in assessing patients who have endometriosis and pelvic pain. Factors found to be important in the assessment of pelvic pain may be different from those involved with the pathophysiology of endometriosis and infertility. The AFS form suggested for use in the management of endometriosis in the presence of pelvic pain allows for recording of variables such as depth of invasion, histology, and documenting adjunct investigations and preoperative physical findings. Such prospective data collection and review in large centers may provide a large clinical base from which to derive empirical point scores and breakpoints in a classification scheme.
为了建立和验证基于特定病理观察的经验性得分的分类系统，多中心合作进行数据收集和统计分析可能是必要的。子宫内膜异位症疼痛评估工具可能是用于某些与盆腔疼痛相关变量的一种手段。对于不孕症，采用类似的统一数据收集策略来分析重要因素也是必要的。创建令人满意的子宫内膜异位症分类的挑战依然存在。目前的分类方案在预测妊娠结局或辅助盆腔疼痛管理方面的能力被认为是不足的。随着对子宫内膜异位症如何导致不孕和盆腔疼痛的理解不断发展，预计会对当前的分类方案进行进一步修订。在分类系统的任何修订中，都应尝试使用基于更大规模临床试验结果数据的经验性权重和断点来定义疾病阶段。此外，诸如CA - 125水平或病变特征等其他因素也可能在预后中发挥重要作用。如果是这样，这些因素必须在分类方案中予以考虑。认真且一致地采用美国生殖医学学会子宫内膜异位症分类小组委员会的建议，应有助于收集数据以供进一步修订使用。有可能一个旨在预测妊娠结局的分类方案在评估患有子宫内膜异位症和盆腔疼痛的患者时可能完全不适用。在评估盆腔疼痛中被发现重要的因素可能与涉及子宫内膜异位症和不孕病理生理学的因素不同。在存在盆腔疼痛的情况下用于子宫内膜异位症管理的AFS表格允许记录诸如浸润深度、组织学等变量，并记录辅助检查和术前体格检查结果。在大型中心进行这样的前瞻性数据收集和审查可能会提供一个庞大的临床基础，从中得出分类方案中的经验性得分和断点。
