Interobserver Reproducibility of Two Endometriosis Scoring Systems: A Multicentre Observational Prospective Study

Area of Science:

• Reproductive Medicine
• Surgical Oncology
• Gynecologic Surgery

Background:

• Endometriosis diagnosis and staging rely on subjective scoring systems.
• Accurate staging is crucial for guiding treatment and predicting fertility outcomes.
• Interobserver variability can impact treatment decisions and research consistency.

Purpose of the Study:

• To evaluate the interobserver reproducibility of the Revised American Society for Reproductive Medicine (r-ASRM) score.
• To assess the interobserver reproducibility of the Endometriosis Fertility Index (EFI).
• To determine the reliability of these scoring systems in women undergoing conservative laparoscopic treatment for endometriosis.

Main Methods:

• A multicenter cross-sectional cohort study involving 100 women undergoing laparoscopy for endometriosis.
• Two independent assessors (specialists, fellows, or residents) evaluated r-ASRM stage/score and EFI during surgery.
• Assessors completed scoring sheets blindly, with consensus reached post-discussion. Reproducibility was measured using Cohen's κ and intraclass correlation coefficients.

Main Results:

• Strong interobserver agreement was observed for r-ASRM stage.
• Almost perfect agreement was found for EFI and Least function score categories.
• Excellent agreement was noted for both r-ASRM and EFI scores, irrespective of assessor expertise or patient history.

Conclusions:

• The r-ASRM and EFI classifications demonstrate high reproducibility among assessors.
• These validated tools can enhance communication and consistency among healthcare professionals in managing endometriosis.
• Further research is needed to address the limitations of these scores in explaining pain symptom variations.