REPRODUCIBILITY OF THE REVISED AMERICAN-FERTILITY-SOCIETY CLASSIFICATION OF ENDOMETRIOSIS USING LAPAROSCOPY OR LAPAROTOMY

Objective: To assess the discrepancy between laparoscopic and laparoto mic scoring methods using the revised American Fertility Society (AFS) classification of endometriosis. Method: In this prospective study, 8 4 patients with endometriosis were scored twice (laparoscopically and laparotomically) by the same subspecialty-certified reproductive endoc rinologist. The magnitude of inter-method variability was reported qua ntitatively by the S.D. of the differences in scores between the pairs . The differences in the mean endometriosis scores between the two met hods were assessed by the paired Student's t-test. P < 0.05 was consid ered as statistically significant. Discrepancy between the two methods in the staging of endometriosis patients was presented by kappa measu re of agreement. Result: There was considerable variability in the sco res between the two scoring methods by the same observer. Among indivi dual components of the scoring system, the greatest variability occurr ed in the ovarian endometriosis and cul-de-sac obliteration subscores, with the least variability observed for peritoneum endometriosis. The inter-method variation in score was sufficient to alter the endometri osis staging in 34.5% of patients, including a difference of two stage s in 3.6% of patients. The kappa coefficient was 0.49, indicating fair -to-good agreement between the two scoring methods. Conclusion: Inter- method variability between laparoscopic and laparotomic scoring method s was high for ovarian endometriosis subscore using the revised AFS cl assification of endometriosis. Agreement in endometriosis staging betw een the two methods was fair to good. (C) 1998 International Federatio n of Gynecology and Obstetrics.