Abstract
Currently, there are up to three different classifications for diagnosing septate uterus. The interobserver agreement among them has been poorly assessed. To assess the interobserver agreement of nonexpert sonographers for classifying septate uterus using the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), American Society for Reproductive Medicine (ASRM), and Congenital Uterine Malformations by Experts (CUME) classifications. A total of 50 three-dimensional (3D) volumes of a nonconsecutive series of women with suspected uterine malformation were used. Two nonexpert examiners evaluated a single 3D volume of the uterus of each woman, blinded to each other. The following measurements were performed: indentation depth, indentation angle, uterine fundal wall thickness, external fundal indentation, and indentation-to-wall-thickness (I:WT) ratio. Each observer had to assign a diagnosis in each case, according to the three classification systems (ESHRE/ESGE, ASRM, and CUME). The interobserver agreement regarding the ESHRE/ESGE, ASRM, and CUME classifications was assessed using the Cohen weighted kappa index (k). Agreement regarding the three classifications (ASRM versus ESHRE/ESGE, ASRM versus CUME, ESHRE/ESGE versus CUME) was also assessed. The interobserver agreement between the 2 nonexpert examiners was good for the ESHRE/ESGE (k = 0.74; 95% confidence interval [CI]: 0.55-0.92) and very good for the ASRM and CUME classification systems (k = 0.95; 95%CI: 0.86-1.00; and k = 0.91; 95%CI: 0.79-1.00, respectively). Agreement between the ESHRE/ESGE and ASRM classifications was moderate for both examiners. Agreement between the ESHRE/ESGE and CUME classifications was moderate for examiner 1 and good for examiner 2. Agreement between the ASRM and CUME classifications was good for both examiners. The three classifications have good (ESHRE/ESGE) or very good (ASRM and CUME) interobserver agreement. Agreement between the ASRM and CUME classifications was higher than that for the ESHRE/ESGE and ASRM and ESHRE/ESGE and CUME classifications.
Highlights
The interobserver agreement between the 2 nonexpert examiners was good for the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) (k 1⁄4 0.74; 95% confidence interval [CI]: 0.55–0.92) and very good for the American Society for Reproductive Medicine (ASRM) and Congenital Uterine Malformations by Experts (CUME) classification systems (k 1⁄4 0.95; 95%CI: 0.86–1.00; and k 1⁄4 0.91; 95%CI: 0.79–1.00, respectively)
Agreement between the ESHRE/ESGE and CUME classifications was moderate for examiner 1 and good for examiner 2
A concordância entre as classificações ESHRE/ESGE e ASRM foi moderada para ambos os examinadores
Summary
Congenital uterine malformations were described for the first time in 1800s and, since several classification systems have been developed for describing different types of uterine and cervical/vaginal anomalies,[1] whose incidence has been reported as of between 0.2 and 0.4% in the general population and of between 3 and 13% in infertile patients.[2,3,4,5,6,7]Classically, septate uterus has been associated with poor reproductive and obstetric outcomes, and surgical metroplasty is advocated in these cases, with the aim of improving these outcomes.[8,9,10,11] Notwithstanding, evidence that this surgery is beneficial is rather arguable.[12]. Three-dimensional (3D) ultrasound has been proposed as the gold standard technique to classify uterine malformations, as it seems to be better to evaluate the level of distortion of the uterine fundus, and to reduce the interobserver variability.[14,15]
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