Interobserver variability in the diagnosis of minimal and mild endometriosis

Study objective: To evaluate the observer's influence on the diagnosis and classification of endometriosis according to the rASRM classification. Design: Prospective analysis. Setting: University hospital. Patients: Digital videotapes of laparoscopies in three patients with typical endometriotic disorders (rASRM 1, 11 and no endometriosis). Intervention: One hundred and eight gynecologic surgeons were asked to indicate the endometriotic lesions on a prepared surgical sketch and to classify the site according to the rASRM classification. Measurements and main results: Total number, location and morphology of endometriotic lesions, rASRM classification. The interobserver correlation concerning the number of lesions ranged between 18% (rASRM 11) and 30%. (rASRM 1). There was marginal correlation regarding the location of endometriotic lesions. Kendall W coefficient ranged from 0.14 (rASRM 11) to 0.44 (rASRM 1) (p < 0.001). Only 13% (rASRM II) to 22% (rASRM I) of observers used the correct endometriotic classification. None of the participants specified the morphological characteristics of endometriotic lesions according to the rASRM classification. Conclusion: Visual assessment of an operative situs with minimal and mild endometriosis is subject to a considerable interindividual variability. One and the same lesion is assessed quite differently by different observers. Histopathological verification seems to be necessary to objectify the diagnosis of endometriosis. (c) 2005 Elsevier Ireland Ltd. All rights reserved.