AUTHOR=Bouquet de Joliniere Jean , Major Attila , Ayoubi Jean Marc , Cabry Rosalie , Khomsi Fathi , Lesec Guy , Frydman René , Feki Anis 

TITLE=It Is Necessary to Purpose an Add-on to the American Classification of Endometriosis? This Disease Can Be Compared to a Malignant Proliferation While Remaining Benign in Most Cases. EndoGram® Is a New Profile Witness of Its Evolutionary Potential

JOURNAL=Frontiers in Surgery

VOLUME=6

YEAR=2019

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2019.00027

DOI=10.3389/fsurg.2019.00027

ISSN=2296-875X

ABSTRACT=<p>Endometriosis is a curious pathology that has been the topic of many international publications. Its etiology remains mysterious but seems to have multiple causes. It is a complex disease whose lesions are very heterogeneous in where they can occur (deep endometriosis, superficial, ovarian cyst), extent, associated symptoms, evolution or aggressiveness of the disease, and response to treatments. Furthermore, it evolves in pushes, remains autonomous, and is responsible for both superficial and deep lesions that explain its two most well know challenges: pain and infertility. It has always been classified by the size of its anatomical lesions—Acosta classification (<xref ref-type="bibr" rid="B1">1</xref>), revised by the American fertility society (AFS) (<xref ref-type="bibr" rid="B2">2</xref>), and the American society of reproductive medicine (ASRM) classification with a description of the disease at different stages: minimal (score of 1 to 5), mild (<xref ref-type="bibr" rid="B3">3</xref>–<xref ref-type="bibr" rid="B12">12</xref>), moderate (16 to 40), and severe (&gt;40) (<xref ref-type="bibr" rid="B13">13</xref>). If this classification provides a complete repertoire of implants (anatomic) (<xref ref-type="bibr" rid="B10">10</xref>), the attribution of points is arbitrary. In fact, the size of the lesions is not synonymous with the difficulty to treat them surgically. Their location, if deep, is larger than the size of ovarian endometriomas. In addition, small anatomical but evaluative lesions will have a larger impact than big fibrous and stable lesions (<xref ref-type="fig" rid="F1">Figure 1</xref>). Thus, attempts to explain their inflammatory side effects have been proposed (<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B15">15</xref>). The French classification nodule, ovaries, adhesions, tube, and inflammation (FOATI) (<xref ref-type="bibr" rid="B10">10</xref>) has had the merit of taking this phenomenon into account. In our opinion, we must go much further and propose an amendment in this classification, taking into account the evolution of the lesions and their deep molecular biology because in reality, the lesions are not at the same stage.</p>