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Multicenter Study
. 2022 Nov;129(12):2052-2061.
doi: 10.1111/1471-0528.17235. Epub 2022 Jun 3.

Preoperative application of the Enzian classification for endometriosis (The cEnzian Study): A prospective international multicenter study

Simon-Hermann Enzelsberger  1 , Peter Oppelt  1 , Konstantinos Nirgianakis  2 , Beata Seeber  3 , Jan Drahoňovský  4 , Leopold Wanderer  5 , Bernhard Krämer  6 , Kristin Nannette Grübling  7 , Sudip Kundu  8 , Darius Salehin  9 , Maciej Mierzwinski  10 , Harald Krentel  11 , Philipp Hermann  12 , Helga Wagner  12   13 , Omar Shebl  1 , Sebastian Schäfer  14
Affiliations
Multicenter Study

Preoperative application of the Enzian classification for endometriosis (The cEnzian Study): A prospective international multicenter study

Simon-Hermann Enzelsberger et al. BJOG. 2022 Nov.

Abstract

Objective: To assess the diagnostic performance of preoperative application of the Enzian classification (cEnzian) using surgical findings as reference standard.

Design: A prospective international non-interventional study.

Setting: Twelve endometriosis centres in four European countries (Austria, Germany, Switzerland and Czech Republic).

Population: 1062 women with endometriosis surgery.

Methods: Extent of endometriosis was preoperatively classified using the cEnzian classification based on gynaecological examination and/or transvaginal ultrasound (TVS) and/or magnetic resonance imaging (MRI). After subsequent surgery, the surgeon classified the intraoperative findings using the Enzian classification.

Main outcome measures: Sensitivity, specificity, PPV, NPV, LR+ , LR- and accuracy were calculated. Conditional frequencies of intraoperative Enzian codings and the corresponding 95% confidence intervals were computed for each preoperative coding and visualised in plots.

Results: Although overall consistency of cEnzian and Enzian was poor (35.14%, 95% confidence interval 32.26-38.03), high specificities and negative predictive values (NPVs) of the cEnzian compartments could be demonstrated. Looking at the individual parts of the Enzian classification, the poorest diagnostic performance was detected for compartment B and the highest PPVs were found for category 3 lesions (>3 cm), independent of the compartment.

Conclusions: Using the Enzian classification in a non-invasive setting is a useful tool providing us with an 'at a glance' summary of the diagnostic workup regarding deep endometriosis with high specificities and NPVs. An attempt to merge the two new endometriosis classification systems (#Enzian and AAGL 2021) seems reasonable taking into consideration the respective advantages of each other.

Keywords: Enzian; classification; endometriosis.

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Conflict of interest statement

None declared. Completed disclosure of interest forms are available to view online as supporting information.

Figures

FIGURE 1
FIGURE 1
Concordance in compartment A.
FIGURE 2
FIGURE 2
Concordance in compartment B.
FIGURE 3
FIGURE 3
Concordance in compartment C.
See this image and copyright information in PMC

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