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. 2024 Oct 9;13(19):6005.
doi: 10.3390/jcm13196005.

Concordance between Preoperative #ENZIANi Score and Postoperative #ENZIANs Score Classification-Why Do We Choose #ENZIAN and How Does It Impact the Future Classification Trend?

Zofia Borowiec  1 , Maja Mrugała  1 , Krzysztof Nowak  1 , Wiktor Bek  1 , Ewa Milnerowicz-Nabzdyk  1
Affiliations

Concordance between Preoperative #ENZIANi Score and Postoperative #ENZIANs Score Classification-Why Do We Choose #ENZIAN and How Does It Impact the Future Classification Trend?

Zofia Borowiec et al. J Clin Med. .

Abstract

Objectives: To assess the concordance of the preoperative application of the #ENZIAN classification (#ENZIANi) with the postoperative result (#ENZIANs) using surgical findings as the reference standard. Methods: This retrospective study included 282 consecutive patients with deep endometriosis undergoing surgical treatment. Preoperative assessment with transvaginal sonography and magnetic resonance imaging was compared with postoperative assessment. Concordance and diagnostic test evaluation were calculated. Results: The highest concordance was observed in the F (abdominal wall endometriosis) with k Cohen of 0.837, following the values for pelvic locations, with 0.795 for T left, 0.791 for T right, 0.776 for F (adenomyosis), 0.766 for C (rectum), and 0.75 and 0.72 for O right k and O left, respectively. The highest sensitivity was demonstrated for the P compartment *(98%), T compartment (both sides 97%), and A, B, C (94-96%), corresponding with deep endometriosis. Conclusions: Preoperative assessment using TVS/TAS + MRI with the ENZIANi score correlates well with the ENZIANs postoperative score and demonstrates good concordance in the detection and localization of deep endometriosis, thereby minimizing false negative results and ensuring accurate preoperative staging. The ENZIAN classification is well-suited to surgeon needs and benefits from continuous development. Future improvements, such as adding the expanded C module, may be considered in the next edition.

Keywords: #ENZIAN; deep endometriosis; endometriosis classification system; minimally invasive surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Preoperative ultrasound examination: the bowel DE nodule (TVS exam), congestion in the left kidney (TAS exam).
Figure 2
Figure 2
Preoperative magnetic resonance examination. The same bowel DE nodule as presented in TVS above (compare Figure 1).
Figure 3
Figure 3
Intraoperative image of laparoscopic procedure—deep endometriosis affecting the bowel the nodule before the excision.
Figure 4
Figure 4
Intraoperative image of laparoscopic procedure—the ICG testing of the bowel after the nodule excision.
Figure 5
Figure 5
Heatmaps showing agreement for selected parameters.
See this image and copyright information in PMC

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