OP06.11: Modification of the four‐stage “AAGL endometriosis classification system” to a three‐stage system: diagnostic accuracy and interobserver reproducibility study

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We aim to assess the performance of a modified AAGL (mAAGL) endometriosis classification system and its inter-observer reproducibility. Retrospective diagnostic accuracy and inter-observer reproducibility study. Patients with complete surgical data included. The original 4-stage AAGL staging system was modified to three stages by merging AAGL stages 2 and 3 and surgical complexity levels B and C. Three observers independently apportioned an AAGL stage 1-3, blinded to surgical skill level (A, B and C). End points were diagnostic performance of each observer to predict level of surgical complexity for each stage, i.e. mAAGL stage 1 to predict level A, mAAGL stage 2 to predict level B, mAAGL stage 3 to predict level C. Inter-observer reproducibility was assessed using OR of a higher grade, between each pair of observers. 272 surgical cases analysed. Breakdown of surgical complexity levels were as follows: A 149 (54.8%), B 103 (37.9%) and C 20 (7.4%). The diagnostic accuracy for all observers to predict each level in terms of sensitivity, specificity, PPV and NPV were: stage 1 to predict level A: 98.0-98.7%, 60.2-64.2%, 75.0-76.9% and 96.3-97.5%; stage 2 to predict level B: 31.1-36.9%, 97.0-98.2%, 86.5-92.6% and 69.8 – 71.9%; stage 3 to predict level C: 90.0-95.0%, 90.1-91.7%, 41.8 - 47.5% and 99.1-99.6%. Inter-observer reproducibility between observer 1 and 2 was 0.81, between observer 1 and 3 was 0.69 and between observer 2 and 3 was 0.43. Overall percentage agreement between observers 1 and 2 was 93.4%, between 1 and 3 was 93.4% and between 2 and 3 was 96.3%. The mAAGL system appears to perform well for both low and high stage endometriosis disease. The 4-stage AAGL staging system could be improved by merging AAGL stages 2 and 3 and in turn using a 3-stage system.

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