Diagnostic accuracy of a novel endometriosis staging system: an external validation study
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abstract
Objective To externally validate the “2021 AAGL Endometriosis
Classification” staging system. Design Retrospective, diagnostic
accuracy study Setting Multicentre Population or Sample Two hundred and
seventy-two endometriosis patients (January 2016 - October 2021) Methods
Three independent observers analysed coded surgical data to assign an
AAGL surgical stage (1 to 4) as the index test, and surgical complexity
level (A to D) as the reference standard. Main Outcome Measures The
diagnostic accuracy of each AAGL stage to predict corresponding AAGL
surgical complexity level was determined. Receiver operating
characteristic curves used to determine the accuracy of cut off points
used in the AAGL staging system to discriminate between surgical
complexity levels. Results 272 cases were analysed. Diagnostic accuracy
(sensitivity, specificity, PPV and NPV) for three observers were: stage
1 to predict level A 97.9-98.7%, 60.2-64.2%, 75.0-76.9%, and
96.3-97.5%; stage 2 to predict level B 26.1-30.4%, 93.2-95.6%,
26.3-35.3%, and 92.9-93.6%; stage 3 to predict level C 7.5-10.0%,
93.8-94.8%, 33.3-42.1%, and 70.9-71.5%; stage 4 to predict level D
90.-95.0%, 90.1-91.7% &, 41.9-47.5%, and 99.1-99.6%. For three
observers AUROC for A vs B/C/D (cut-point 9) 0.75-0.88, A/B vs C/D
(cut-point 16) 0.81 and A/B/C vs D (cut-point 22) 0.95-0.96. Conclusions
This external validation study demonstrates that the AAGL Endometriosis
Classification performs poorly overall for the prediction of surgical
complexity. The results from this external validation study suggest that
the system in its current form is not generalizable to all endometriosis
patients and should be reviewed before its universal implementation.
Funding Nil Keywords Endometriosis, staging, laparoscopy
