The 2021 AAGL Endometriosis Classification Is a Fundamental Patient-centered Step Forward

Staging of disease is essential for all clinical and research activity related to it. Staging of endometriosis has been a matter of controversy for decades, and the debate is ongoing. No staging system is omnicompetent and useful for all aspects of endometriosis care. Rather, different staging criteria can be considered depending on the clinical scenario. However, it is important that the staging system be a valid one: that is to say, that it will correctly capture what it is designed to capture. In this issue of Journal of Minimally Invasive Gynecology, there are 2 studies that focus either on the disillusionment or advancement of the American Association of Gynecologic Laparoscopists (AAGL) 2021 endometriosis classification [ 1 Abrao MS Andres MP Miller CE et al. AAGL 2021 endometriosis classification: an anatomy-based surgical complexity score. J Minim Invasive Gynecol. 2021; 28: 1941-1950.e1 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar ]. One study, by Mak et al [ 2 Mak J Eathorne A Leonardi M et al. External validation of the “2021 AAGL Endometriosis Classification”: a retrospective cohort study. J Minim Invasive Gynecol. 2023; 30: 374-381 Abstract Full Text Full Text PDF Scopus (1) Google Scholar ], argues that the AAGL system does not outperform previous endometriosis classification systems and therefore should not be widely used. The second study, by Abrao et al [ 3 Abrao MS Andres MP Gingold JA et al. Preoperative ultrasound scoring of endometriosis by AAGL 2021 endometriosis classification is concordant with laparoscopic surgical findings and distinguishes early from advanced stages. J Minim Invasive Gynecol. 2023; (Forthcoming) Google Scholar ], describes the utility of preoperative ultrasound assessment in concordance with the AAGL system to accurately predict and classify low-stage and high-stage endometriosis cases and further promotes the utilization of AAGL system. External Validation of the “2021 AAGL Endometriosis Classification”: A Retrospective Cohort StudyJournal of Minimally Invasive GynecologyVol. 30Issue 5PreviewExternally validate the American Association of Gynecologic Laparoscopists (AAGL) staging system against surgical complexity and compare diagnostic accuracy with revised American Society for Reproductive Medicine (rASRM) stage, as was done in original publication. Full-Text PDF Preoperative Ultrasound Scoring of Endometriosis by AAGL 2021 Endometriosis Classification Is Concordant with Laparoscopic Surgical Findings and Distinguishes Early from Advanced StagesJournal of Minimally Invasive GynecologyVol. 30Issue 5PreviewTo compare the accuracy of preoperative ultrasound (US) in predicting the laparoscopically defined 2021 American Association of Gynecologic Laparoscopists (AAGL) Endometriosis Staging. Full-Text PDF