{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:17:37Z","timestamp":1782969457646,"version":"3.54.5"},"reference-count":47,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,12,9]],"date-time":"2016-12-09T00:00:00Z","timestamp":1481241600000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop and assess the performance of a preoperative ultrasound\u2010based endometriosis staging system (<jats:styled-content style=\"fixed-case\">UBESS<\/jats:styled-content>) to predict the level of complexity of laparoscopic surgery for endometriosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a multicenter prospective and retrospective cohort study on consecutive women with suspected endometriosis who underwent laparoscopy between June 2009 and July 2013. Each woman underwent a systematic transvaginal ultrasound evaluation to assess the pelvis for different phenotypes of endometriosis, and the diagnostic performance of ultrasound for these different phenotypes was evaluated relative to the gold standard, laparoscopy. A three\u2010stage preoperative <jats:styled-content style=\"fixed-case\">UBESS<\/jats:styled-content> was developed to assess the severity of pelvic endometriosis, based on the histological phenotypes of endometriosis, the anatomical locations of deep infiltrating endometriosis and their sonographic markers of local invasiveness. The three stages of <jats:styled-content style=\"fixed-case\">UBESS<\/jats:styled-content> (I\u2013<jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>) were then correlated with the three levels of complexity of laparoscopic surgery for endometriosis described by the Royal College of Obstetricians and Gynaecologists (Levels 1\u20133). The end\u2010points were the diagnostic performance of <jats:styled-content style=\"fixed-case\">UBESS<\/jats:styled-content> to predict the level of complexity of laparoscopic surgery for endometriosis, i.e. <jats:styled-content style=\"fixed-case\">UBESS<\/jats:styled-content> stage I to predict Level\u20101 laparoscopic surgery, <jats:styled-content style=\"fixed-case\">UBESS<\/jats:styled-content> stage <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> to predict Level\u20102 laparoscopic surgery and <jats:styled-content style=\"fixed-case\">UBESS<\/jats:styled-content> stage <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> to predict Level\u20103 laparoscopic surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The analysis included 192 women, with a mean \u00b1 <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> age at diagnosis of endometriosis of 23.7 \u00b1 9.3 years and a mean duration of symptoms prior to presentation of 42 months. Predominant reported  locations of pelvic pain were left iliac fossa (32%), right iliac fossa (29.5%) and lower abdomen (61%) and predominant symptoms included dyspareunia (57.5%), dysmenorrhea (58.5%) and dyschezia (41.5%). The accuracy, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of <jats:styled-content style=\"fixed-case\">UBESS<\/jats:styled-content> I for predicting a requirement for Level\u20101 laparoscopic surgery were: 87.5%, 83.3%, 91.7%, 90.9%, 84.6%, 10 and 0.182; those of <jats:styled-content style=\"fixed-case\">UBESS II<\/jats:styled-content> for predicting Level\u20102 surgery were: 87.0%, 73.7%, 90.3%, 65.1%, 93.3%, 7.6 and 0.292; and those of <jats:styled-content style=\"fixed-case\">UBESS III<\/jats:styled-content> for predicting Level\u20103 surgery were: 95.3%, 94.8%, 95.5%, 90.2%, 97.7%, 21.2 and 0.054, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">UBESS<\/jats:styled-content> could be utilized to predict the level of complexity of laparoscopic surgery for endometriosis. It has the potential to facilitate the triage of women with suspected endometriosis to the most appropriate surgical expertise required for laparoscopic endometriosis surgery. <jats:styled-content style=\"fixed-case\">UBESS<\/jats:styled-content> needs to be validated externally in multiple centers to assess its general applicability. Copyright \u00a9 2016 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.15858","type":"journal-article","created":{"date-parts":[[2016,1,14]],"date-time":"2016-01-14T12:45:19Z","timestamp":1452775519000},"page":"786-795","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":82,"title":["Performance of  ultrasound\u2010based endometriosis staging system (<scp>UBESS<\/scp>) for predicting level of complexity of laparoscopic surgery for endometriosis"],"prefix":"10.1002","volume":"48","author":[{"given":"U.","family":"Menakaya","sequence":"first","affiliation":[{"name":"Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean University of Sydney, Nepean Hospital  Kingswood NSW Australia"},{"name":"JUNIC Specialist Imaging and Women's Center  Canberra, ACT Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Wollongong Hospital  Wollongong NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Lu","sequence":"additional","affiliation":[{"name":"University of Wales  Aberystwyth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Bassem","sequence":"additional","affiliation":[{"name":"Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean University of Sydney, Nepean Hospital  Kingswood NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Infante","sequence":"additional","affiliation":[{"name":"Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean University of Sydney, Nepean Hospital  Kingswood NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Condous","sequence":"additional","affiliation":[{"name":"Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean University of Sydney, Nepean Hospital  Kingswood NSW Australia"},{"name":"OMNI Gynaecological Care Centre for Women's Ultrasound and Early Pregnancy  St Leonards, Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,12,9]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2012.05.031"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1000274"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/det050"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgyn.2012.11.009"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2004.03.046"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1074-3804(05)60190-9"},{"key":"e_1_2_6_8_1","first-page":"118","article-title":"The \u201csliding sign\u201d in conjunction with sonovaginography: is this the optimal approach for the diagnosis of pouch of douglas obliteration and posterior compartment deep infiltrating endometriosis?","volume":"16","author":"Menakaya UA","year":"2013","journal-title":"AJUM"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2011.05951.x"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.8858"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2012.31.4.651"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.7863\/ultra.34.6.937"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2014.02.013"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.00849.x"},{"key":"e_1_2_6_15_1","first-page":"2","article-title":"Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? 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