3 years ago

Congenital Uterine Malformation by Experts (CUME): better criteria for distinguishing between normal/arcuate and septate uterus

Felice Petraglia, George Condous, William Gibbons, Beryl Benacerraf, Maribel Acién, Artur Ludwin, Antonio Pellicer, Rudy-Leon De Wilde, Ertan Saridogan, Stefano Guerriero, Mark Hans Emanuel, Carolina O. Nastri, Valeria M. Leitão, Wellington P. Martins, Juan L. Alcazar, Inga Ludwin, Deborah Levine, Marcela A. Coelho Neto, William W. Hurd, Steven Lindheim
Objectives To assess whether level of agreement among experts in distinguishing between septate and normal/arcuate uterus using subjective judgments from review of coronal view from three-dimensional ultrasound. We also aim to determine the inter-observer reliability and diagnostic test accuracy of three measurements suggested by recent guidelines, using the most voted option by experts (CUME - Congenital Uterine Malformation by Experts) as a reference standard. Methods Images of the coronal plane of the uterus from 100 women with suspected fundal internal indentation were anonymized and submitted to 15 experts (5 clinicians, 5 surgeons and 5 sonologists). They were instructed to vote between normal/arcuate (normal uterine morphology or degree of distortion caused by the internal indentation is not clinically relevant) or septate uterus (the degree of distortion caused by the internal indentation is clinically relevant). Two other raters independently measured indentation depth, indentation angle and indentation to wall thickness (I:WT) ratio. The agreement among experts was assessed by kappa, the inter-rater reliability was assessed by concordance correlation coefficient (CCC), the diagnostic test accuracy was assessed by the area under ROC curve (AUROC) and the best cut-off value was assessed using Youden's index, considering the most voted option (CUME) as the reference standard. Results There was a good agreement among the impression of all experts (kappa = 0.62). There were 18 septate and 82 normal/arcuate uteri by CUME; ESHRE-ESGE criteria (I:WT ratio > 50%) resulted in 80 septate and 20 normal/arcuate, while ASRM criteria resulted in 5 septate (depth > 15 mm and angle < 90°), 82 normal/arcuate (depth < 10 mm and angle > 90°) and 13 uterus would not be classified (gray-zone). The agreement between ESHRE-ESGE and CUME was 38% (kappa = 0.10); the agreement between ASRM criteria for septate and CUME was 87% (kappa = 0.39), and considering both septate and gray-zone as septate, the agreement was 98% (kappa = 0.93). Among the three measurements, the inter-rater reproducibility of indentation depth (CCC=0.99, 95%CI=0.98-0.99) was better than both indentation angle (CCC=0.96, 95%CI=0.94-0.97) and I:WT ratio (CCC=0.92, 95%CI=0.90-0.94). The diagnostic test accuracy of these three measurements using CUME as reference standard was very good: AUROC between 0.96 and 1.00. The best cut-off values for these measurements were: indentation depth ≥ 10 mm, indentation angle < 140°, and I:WT ratio > 110% . Conclusions The suggested cut-off value by ESHRE-ESGE overestimates the prevalence of septate uterus while those by ASRM underestimate this prevalence, leaving in the gray zone most of the uteri considered as being septate by experts. We recommend considering indentation depth ≥ 10 mm as septate, since it is simple, reliable and in agreement with the opinion of experts.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18923

You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.