From the Gynecologic Division, BP-A Beneficência Portuguesa de São Paulo (Drs Abrao, Andres and Neto), São Paulo, Brazil; Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo (Drs Abrao, and Andres), Sao Paulo, Brazil.
Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo (Drs Abrao, and Andres), Sao Paulo, Brazil.
J Minim Invasive Gynecol. 2023 May;30(5):363-373. doi: 10.1016/j.jmig.2022.11.003. Epub 2022 Nov 18.
To compare the accuracy of preoperative ultrasound (US) in predicting the laparoscopically defined 2021 American Association of Gynecologic Laparoscopists (AAGL) Endometriosis Staging.
Retrospective multicenter study of patients treated at 3 specialized endometriosis centers.
Three specialized endometriosis surgical centers in São Paulo (Brazil), Barcelona (Spain), and Avellino (Italy) participated.
A total of 878 patients aged 15 to 45 years with no history of pelvic malignancy underwent laparoscopic (LPS) treatment for suspected endometriosis.
Retrospective review of preoperative transvaginal and transabdominal US (index test) assessed for endometriosis at all sites used in the 2021 AAGL Endometriosis Classification and classified patients into AAGL-US stages 1 to 4. Results were compared with reference-standard LPS (AAGL-LPS) staging.
The AAGL-US and AAGL-LPS stage were concordant in 586 cases (66.7%) (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.
Sonographic estimation of the 2021 AAGL Endometriosis Staging is greatest in AAGL-LPS stages 1 and 4 and among patients with no endometriosis. US best identifies endometriosis of the ovaries, bladder, and bowel but is more limited for the tubes and superficial peritoneum.
比较术前超声（US）预测腹腔镜下 2021 年美国妇科腹腔镜医师协会（AAGL）子宫内膜异位症分期的准确性。
在 3 个专门的子宫内膜异位症中心进行的回顾性多中心研究。
来自巴西圣保罗、西班牙巴塞罗那和意大利阿韦利诺的 3 个专门的子宫内膜异位症外科中心参与了这项研究。
共 878 名年龄在 15 至 45 岁之间、无盆腔恶性肿瘤病史的患者因疑似子宫内膜异位症接受腹腔镜（LPS）治疗。
回顾性分析术前经阴道和经腹超声（指数试验），评估 2021 年 AAGL 子宫内膜异位症分类中所有部位的子宫内膜异位症，并根据 AAGL-US 分期 1 至 4 对患者进行分类。结果与参考标准 LPS（AAGL-LPS）分期进行比较。
AAGL-US 与 AAGL-LPS 分期在 586 例（66.7%）患者中一致（加权 Kappa [WK] 0.759；组内相关系数=0.906），在无子宫内膜异位症患者（n=70，75.3%一致）、AAGL-LPS 1 期（104 例，50.7%）和 4 期疾病（358 例，88.2%）中观察到最高的一致性。直肠/乙状结肠（WK 0.862）、膀胱（WK 0.911）和卵巢（右/左侧分别为 WK 0.835/0.795）的子宫内膜异位症诊断最准确，而腹膜表面（WK 0.442）、输卵管（WK 0.391/0.363 分别为右/左侧）和子宫颈后/子宫骶骨韧带（WK 0.656）部位的子宫内膜异位症诊断最不准确。
在 AAGL-LPS 分期 1 期和 4 期和无子宫内膜异位症的患者中，超声对 2021 年 AAGL 子宫内膜异位症分期的估计最大。US 最能识别卵巢、膀胱和肠道的子宫内膜异位症，但对输卵管和腹膜表面的识别能力有限。
