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Appendix

The Revised AFS Classification of Endometriosis

AFS Clasification of Endometriosis

Patient's Name

Stage Stage II I

(Minimal)· 1-5

(Mild)

.6-15

Laparoscopy

Stage III

(Moderate)· 16-40

Recommended Treatment

Stage

IV

(Severe)

. > 40

Total

Prognosis

Date

Laparotomy

P!

 

----

 

ENDOMETRIOSIS

< lcm

1-3cm

!

 

Superficial

1

2

Deep

2

4

 

R

Superficial

1

2

;

Deep

4

16

0

L

Superficial

1

2

 

Deep

4

16

 

POSTERIOR

Partial

CULDESAC

OBLITERATION

4

ADHESIONS

< 113 Enclosure

1/3 - 2/3 Enclosure

;

R

Filmy

1

2

 

Dense

4

8

0

 

L Filmy

1

2

 

Dense

4

8

 

R

Filmy

1

2

f;;il

Dense

4*

8*

;;:I

L

Filmy

1

2

E-<

 

Dense

4*

8*

loograp t h y-------

>3cm

4

6

4

20

4

20

Complete

40

> 2/3 Enclosure

4

16

4

16

4

16

4

16

• ff the fimbriated end of the fallopian tube is completely enclosed, change the point assignment to 16.

Additional Endometriosis:

216

To Be Used with Normal Tubes and Ovaries

Associated Pathology:

To Be Used with Abnormal Tubes and/or Ovaries

L

R

The Revised AFS Classification of Endometriosis

STAGE I (MINIMAL)

EXAMPLES & GIDDELINES

STAGE II (MILD)

STAGE III (MODERATE)

PERITONEUM Superficial Endo R. OVARY

1-3cm

-2

Superficial Endo

<I cm

-

I

Filmy Adhesions

<113.

-

I

TOTAL POINTS

4

STAGE III (MODERATE)

 

PERITONEUM Superficial Endo R. TUBE

>3cm

-4

Filmy Adhesions

<113

-

1

R.OVARY Filmy Adhesions

<1/3

- 1

L. TUBE Dense Adhesions L.OVARY

<113

- 16 *

Deep Endo

<lcm

-4

Dense Adhesions

<113

-4

TOTAL POINTS

30

PERITONEUM Deep Endo R.OVARY Superficial Endo Filmy Adhesions L. OVARY Superficial Endo TOTAL POINTS

S u p e r f i c i a l E n d o Filmy
S u p e r f i c i a l E n d o Filmy
S u p e r f i c i a l E n d o Filmy

>3cm

<lcm

<113

<lcm

STAGE IV (SEVERE)

PERITONEUM Snperficial Endo L.OVARY Deep Endo Dense Adhesions L. TUBE Dense Adhesions TOTAL POINTS

Y D e e p E n d o Dense Adhesions L . T U B
Y D e e p E n d o Dense Adhesions L . T U B
Y D e e p E n d o Dense Adhesions L . T U B

>3cm

1-3cm

<1-3

<1/3

*Point assignment changed to 16 **Point assignment doubled

- 6

PERITONEUM Deep Endo

>3cm

-6

- 1

CULDESAC Partial Obliteration

-4

-1

L. OVARY

Deep Endo

1-3cm

- 16

-

I

TOTAL POINTS

26

9

-4

- 32 **

- 8 *'

- 8 **

52

STAGE IV (SEVERE)

PERITONEUM DeepEndo

>3cm

1-3cm

<113

-6

CULDESAC Complete Obliteration R.OVARY

-40

Deep Endo

-16

Dense Adhesions

-4

L. TUBE Dense Adhesions

>213

1-3

>213

- 16

L.OVARY Deep Endo

- 16

Dense Adhesions

-16

TOTAL POINTS

114

Determination of the stage or degree of endometrial in- volvement is based on a weighted point sytem. Distribution of points has been arbitrarily determined and may require further revision or refinement as knowledge of the disease increases. To ensure complete evaluation, inspection of the pelvis in a clockwise or counterclockwise fashion is encouraged. Number, size and location of endometrial implants, plaqnes, endometriomas and/or adhesions are noted. For example, five separate 0.5cm superficial implants on the peritoneum (2.5 em total) would be assigned 2 points. (The surface of the uterus should be considered peritoneum.) The severity of the endometriosis or adhesions should be assigned the highest score only for peritoneum, ovary, tube or culdesac. For example, a 4cm superficial and a 2cm deep implant of the peritoneum should be given a score of 6 (not 8). A 4cm

deep endometrioma of the ovary associated with more than 3cm of superficial disease should be scored 20 (not 24). In those patients with only one adnexa, points applied to disease of the remaining tube and ovary should be multiplied by two. "Points assigned may be circled and totaled. Aggre- gation of points indicates stage of disease (minimal, mild, moderate, or severe). The presence of endometriosis of the bowel, urinary tract, fallopian tube, vagina, cervix, skin etc., should be docu- mented under "additional endometriosis." Other pathology such as tubal occlusion, leiomyomata, urine anomaly, etc., should be documented under "associated pathology." All pathology should be depicted as specifically as possible on the sketch of pelvic organs and means of observation (lapa- roscopy or laparotomy) should be noted.

217