title: Comparison of revised American Fertility Society and ENZIAN staging: a critical evaluation of classifications of endometriosis on the basis of our patient population.
abstract: OBJECTIVE
  To develop a classification that takes deep infiltrating endometriosis into account, the ENZIAN score was introduced. The ENZIAN classification supplements the revised American Fertility Society (AFS) score with regard to the description of deep infiltrating endometriosis, retroperitoneal structures, and other organs. The null hypothesis was that classifying a lesion by the revised AFS as well as the ENZIAN system is not meaningful, because the two systems express different locations.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Hospital admissions.
  
  
  METHODS
  Two hundred nineteen women admitted for endometriosis.
  
  
  METHODS
  Surgical interventions.
  
  
  METHODS
  Classification of the severity of endometriosis according to the revised AFS and the ENZIAN classification, focusing on the distribution pattern in deep infiltrating endometriosis, and the identification of duplicate classifications of the same lesions in the revised AFS as well as the ENZIAN systems.
  
  
  RESULTS
  Deep infiltrating endometriosis was diagnosed in 160 of 219 patients (73%). These patients had 236 lesions of deep infiltrating endometriosis, which were classified by ENZIAN as follows: compartment a (vertical): 26%; compartment b (horizontal): 41%; compartment c (dorsal): 24%; uterine adenomyosis: 4%; bladder disease: 2%; ureter disease: 1%; and bowel disease: 2%. The severity of deep infiltrating endometriosis according to ENZIAN (grades 1 = mild to 4 = severe) was as follows: grade 1: 45%; grade 2: 26%; grade 3: 19%; grade 4: 10%. Fifty-eight patients were classified according to ENZIAN although they did not fulfill the criteria of deep infiltrating endometriosis and had previously been classified according to the revised AFS classification. Adaptation of the ENZIAN score would reduce the diagnoses of deep infiltrating endometriosis by 36% (95% confidence interval [CI] 29%-44%).
  
  
  CONCLUSIONS
  The ENZIAN score is a helpful aid to describe deep infiltrating endometriosis, but needs to be adapted.
authors.affiliation: General Hospital Linz, Department of Obstetrics and Gynecology, Linz, Austria. dietmar.haas@akh.linz.at
authors.forename: Dietmar
authors.initials: D
authors.lastname: Haas
authors.forename: Radek
authors.initials: R
authors.lastname: Chvatal
authors.forename: Alwin
authors.initials: A
authors.lastname: Habelsberger
authors.forename: Peter
authors.initials: P
authors.lastname: Wurm
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schimetta
authors.forename: Peter
authors.initials: P
authors.lastname: Oppelt
mesh_terms: D000328:Adult; D003944:Diagnostic Techniques, Obstetrical and Gynecological; D004312:Douglas' Pouch / Q000473:pathology; D004715:Endometriosis / Q000145:classification* / Q000175:diagnosis / Q000473:pathology; D005260:Female; D005298:Fertility / Q000502:physiology; D006801:Humans; D008954:Models, Biological; D010532:Peritoneal Diseases / Q000145:classification* / Q000175:diagnosis / Q000473:pathology; D011153:Population; D012107:Research Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012955:Societies, Medical; D014481:United States; D014591:Uterine Diseases / Q000145:classification / Q000473:pathology