Bindra Vimee, Madhavi Nori, Mohanty Girija Shankar, Nivya K, Balakrishna N
Apollo Hospital, Hyderabad, India.
Madhavi Scan Centre, Hyderabad, India.
Arch Gynecol Obstet. 2023 Jan;307(1):179-186. doi: 10.1007/s00404-022-06494-4. Epub 2022 Mar 14.
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.
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.
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.
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.
本研究的目的是使用最新版的#ENZIAN分类法，评估并比较采用结构化报告的超声检查（USG）与术中腹腔镜评估在深部浸润性子宫内膜异位症（DIE）中的诊断性能。
这是一项在三级多学科子宫内膜异位症护理医院进行的回顾性研究，为期8个月，纳入了50例患者，这些患者于2021年2月至2021年9月在海得拉巴的阿波罗医院，在使用国际深部子宫内膜异位症分析（IDEA）方案和#ENZIAN评分（更新后的ENZIAN分类）进行专门的超声检查评估后，接受了计划性腹腔镜子宫内膜异位症切除手术。术前超声检查结果采用结构化报告形式进行报告，术中发现采用标准的#ENZIAN分类法进行分类。未进行前瞻性干预。根据#ENZIAN对术前超声和腹腔镜检查结果进行了回顾。
超声检查对腹膜病变的敏感性和阴性预测值分别为86%和84.2%，对左侧卵巢病变为97%和93.3%，对右侧卵巢病变为93%和91.6%，对左侧输卵管病变为91%和84%，对右侧输卵管病变为90%和86.3%，对子宫骶骨韧带为93%和75%，对直肠病变为93.3%和97%，对直肠阴道病变、子宫腺肌病和输尿管病变的敏感性和阴性预测值经腹腔镜检查证实为100%。
基于IDEA方案和#ENZIAN评分的动态超声评估结合结构化报告，对于所有形式的盆腔子宫内膜异位症的定位准确，且与腹腔镜检查结果相关，从而有助于外科医生更好地规划手术，并为外科医生提供路线图。从临床角度来看，跨影像和治疗方式的统一且共享的报告系统将简化沟通，通过保守或手术治疗改善患者管理，避免多次重复手术，并提高治疗质量。
