Ultrasound-based endometriosis staging system: validation study to predict complexity of laparoscopic surgery

Jessica Tompsett, Mathew Leonardi, Bassem Gerges, Chuan Lu, Shannon Reid, Mercedes Espada, George Condous

Research output: Contribution to journalArticlepeer-review

17 Citations (SciVal)


Study Objective
: To validate the preoperative ultrasound-based endometriosis staging system (UBESS) for predicting the correct Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australasian Gynaecological Endoscopy and Surgery (AGES) Society's level of laparoscopic skill level required for endometriosis surgery.

: Multi-center retrospective cohort study (Canadian Task Force II-2).

: A tertiary teaching hospital and a private gynecological clinic.

: 155 women presenting with chronic pelvic pain and/or a history of endometriosis.

: Women underwent detailed specialized transvaginal ultrasound (TVS) in a tertiary referral unit to diagnose and stage endometriosis using the three stages of UBESS. The UBESS was correlated to RANZCOG/AGES laparoscopic skill levels. The UBESS classifications were correlated as such: UBESS I to predict RANZCOG/AGES surgical skill levels 1/2, UBESS II to predict RANZCOG/AGES skill levels 3/4 and UBESS III to predict RANZCOG/AGES skill level 6.

Main Results
: The accuracy, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of the UBESS I to predict the RANZCOG/AGES surgical skill levels 1/2 were: 99.4%, 98.9%, 100%, 100%, 98.5%, inf and .011; those of UBESS II to predict surgical skill levels 3/4 were: 98.1%, 96.8%, 98.4%, 93.8%, 99.2%, 60 and .033; and those for UBESS III to predict surgical skill level 6 were: 98.7%, 97.2%, 99.2%, 97.2%, 99.2%, 115.7 and 0.028, respectively. The rate of correctly predicting the exact level of skills needed was 98.1%, and Cohen's kappa statistic for the agreement between UBESS prediction and levels of training required at surgery is 0.97, indicating almost perfect agreement.

: The UBESS can be utilized to predict the level of complexity of laparoscopic surgery for endometriosis based on the RANZCOG/AGES skills levels for laparoscopy. It now needs to be externally validated in multiple centers with various surgical skill level classification systems to assess the general applicability
Original languageEnglish
Pages (from-to)477-483
Number of pages7
JournalJournal of Minimally Invasive Gynecology
Issue number3
Early online date08 Jun 2018
Publication statusE-pub ahead of print - 08 Jun 2018


  • laparoscopy
  • endometriosis
  • preoperative staging
  • transvaginal ultrasound


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