The #Enzian classification for ultrasound diagnosis of endometriosis: description and explanation of the classification using our own clinical cases

Abstract

An extensive deep infiltrating endometriosis usually requires complex and time-consuming surgical treatment, often with multidisciplinary surgery teams forming. The goal of ultrasound is to find and describe in detail, if possible, all endometriosis lesions at the preoperative stage. A structured classification is needed for a detailed description of all foci of pelvic and extrapelvic endometriosis that would be understandable to both the radiologists and the gynecological surgeon. The current version of the #Enzian classification was designed by an international team of scientists from 11 countries with vast experience in the diagnosis and treatment of endometriosis. This classification is based on a description of the location of endometriosis lesions, the depth of invasion into the pelvic organs and tissues, as well as the presence of invasion into adjacent abdominal organs and disruption of their functions. The classification provides continuity between preoperative imaging and surgical assessment of the severity of endometriosis. In this article, we tried to describe and comment in detail on the ultrasound version of this classification, illustrated by our own clinical cases. Using the #Enzian classification provides clinicians with a common “language” to describe endometriosis in a comprehensive and easily reproducible manner. The authors of this article have been using the #Enzian classification in their work for more than 2 years. Based on our existing experience, we consider the #Enzian classification not only convenient and useful, but also meets all the requirements of both a diagnostician and a surgeon.