Classification of Endometriosis

Abstract

The classification of endometriosis has evolved during this century under the influence of many factors. Although classifications initially paralleled the staging of pelvic malignancies, more modern systems follow the natural progression of this pathologic process. The diagnosis of endometriosis at earlier stages has been limited by the technology of the era. Previously, only patients with more severe disease or symptoms were evaluated and treated. Earlier therapies were more radical and centered on pain relief achieved with removal of the internal genitalia. The objectives of classification were to provide standardized documentation of the disease and--it was hoped--define those patients amenable to less radical therapy. As our diagnostic and therapeutic capabilities grew, so did our interest in infertile women with endometriosis and the treatment of such patients. The diagnosis of endometriosis was often made at an earlier stage of involvement, and therapy stressed repair rather than removal. Description of pelvic involvement, has become more detailed and accurate, and the stage of disease has become prognostic of future fertility. The basic tenet of the R-AFS classification system is to provide an objective and universal method for describing the severity of disease visualized at laparotomy or laparoscopy. Stage of disease will aid the physician in choosing the therapy most suited for the individual patient. If reparative surgery is undertaken, the stage of disease will reflect the extent of pelvic reconstruction required. Quantifying disease severity will, it is hoped, make it predictive of success in conception and prognostic of the need for future medical or surgical treatment. It will also serve to stratify patients with a similar degree and distribution of disease into somewhat homogeneous groups. This will permit reasonable comparisons of effectiveness of different therapies and investigators' methods. Refinement of this type of classification scheme will depend on critical analysis of the system's prognostic capabilities. Further studies will help elucidate the relative importance of individual variables on the potential for success in achieving pregnancy.