OP16.01: 3D‐SIS in differential diagnosis of septate, bicornuate and arcuate uterus; the comparative study of accuracy with 2D‐TVS, 3D‐TVS and 2D‐SIS

Abstract

Objectives: To evaluate the diagnostic accuracy of 3D-SIS, 3D-TVS, 2D-TVS (initial TVS diagnosis and an expert TVS) and 2D-SIS in the differential diagnosis of septate, bicornuate and arcuate uteri. Methods: 117 women with recurrent abortion or infertility and 2D-TVS initial diagnosis of septate, bicornuate or arcuate uterus were included in the study. Diagnostics work-up comprised of initial 2D-TVS diagnosis, followed by 2D-TVS performed by an experienced examiners, 3D-TVS, 2D-SIS and 3D-SIS. In order to assess the accuracy of these methods all the patients underwent hysterolaparoscopy (HL) to establish the final diagnosis. The correlation between the results of each method was evaluated and diagnostic accuracy of each method was assessed in the whole group of women as well as in the subgroups of arcuate, septate and bicornuate uteri using receiver operator curves (ROC) method by estimating the area under the curve (AUC). Results: The 3D-SIS was found to be the best diagnostic method with an exact agreement with HL-obtained diagnosis. Other tools had a lower positive correlation (gamma index 3D-TVS: 0.93; 2D-SIS: 0.89, 2D-TVS by expert user: 0.77; and initial 2D-TVS: 0.48; all statistically significant, P < 0.001). All techniques, except initial 2DTVS diagnosis, were found to have the highest (100%) accuracy, sensitivity and specificity in detection of bicornuate uterus cases. Both 2D-SIS and 3D-SIS were found to be better tools in detection of septate uterus (ACC 100%). They were followed by 3D-USG (ACC 97.5%). In diagnosis of arcuate uterus, after 3D-SIS,the 3D-TVS was found to have the highest accuracy (96.2%). Conclusions: 3D-SIS is the most accurate differentiation method of septate, bicornuate and arcuate uterus. It should be used in cases of ambiguous 3D-TVS results. 2D-SIS is comparable to 3D-SIS in differentiation of septate uterus with bicornuate uterus and it may be used in order to verify 2D-TVS results that depend on the investigator’s experience, especially when the access to 3D-imaging technology is restricted.