The current staging system for endometriosis: does it help?

Sampson began to classify endometriosis in graded stages as early as 1921 [1]. Despite its long recognition as a continued and progressive disease process, the etiology, pathophysiology, and natural history of endometriosis remain unpredictable. Ideally, a classification system should correlate. outcomes with an observed stage of disease. Predictable treatment responses also should be related to stage, allowing a prognosis to be given based on the observed stage and the potential response to treatment. Given these parameters, most staging systems for endometriosis have been modeled after those for malignant disease. Unfortunately, treatment outcome for the symptoms of endometriosis may not depend on volume of disease or even morphologic types of lesions. There is current recognition that the existing system for endometriosis classification does not meet these criteria well in terms of predicting treatment response for either infertility or chronic pelvic pain. :Potential sources of error include observational error, incomplete knowledge of the pathophysiology of the disease with a failure to consider morphologic lesion types, limited reproducibility, and the arbitrariness of the scoring system [2-5].