EP27.04: Normal/arcuate vs septate uterus: agreement between currently recommended cut‐off values for measurements and experts' opinion
Year: 2017
Type: conference-abstract
Abstract: To evaluate the agreement between ESHRE/ESGE and ASRM criteria and with the experts' opinion. We included 100 women evaluated between Jun-2016 and Jul-2016 with suspected uterine anomaly. The images of the coronal plane of these uteri were submitted to 15 experts for distinguishing between normal/arcuate (normal uterine morphology or degree of distortion caused by the internal indentation is not clinically relevant) and septate uterus (the degree of distortion caused by the internal indentation is clinically relevant). Two observers (>10y experience with 3D-ultrasound), blinded to each other results and to the opinion of the experts, measured the indentation depth, indentation angle, and indentation to wall thickness (I:WT) ratio. The average value considering both measurements was used to classify the uterus as normal/arcuate or septate using ESHRE-ESGE (septate when I:WT ratio >50%) and ASRM criteria (septate when indentation depth >1.5cm and indentation angle <90°; normal/arcuate when indentation depth <1.0cm and indentation angle >90°). We calculated the observed agreement, kappa, and proportion of false positive (FP) and false negative (FN). There were 18 septate and 82 normal/arcuate uteri based on the experts' opinion. ESHRE-ESGE criterion resulted in 80 septate and only 20 normal/arcuate, while ASRM criteria resulted in 5 septate, 82 normal/arcuate and 13 uterus would not be classified (gray-zone). The agreement between ESHRE-ESGE and the opinion of experts was only 38% (FP=62%, FN=0%, kappa=0.10); the agreement between ASRM criteria for septate and the opinion of experts was 87% (FP=0%, FN=13%, kappa=0.39), and considering both septate and gray zone as septate, the agreement was 98% (FP=1%, FN=1%, kappa=0.93). The suggested cut-off by ESHRE-ESGE greatly overestimates the prevalence of septate uterus, while the definition by ASRM underestimates the prevalence of septate uteri, leaving most of them in the gray zone.
DOI: 10.1002/uog.18756
Institutions: Jagiellonian University, Universidade de São Paulo, Universidad de Navarra, Harvard University, The University of Sydney, Nepean Hospital, Carl von Ossietzky Universität Oldenburg, Spaarne Ziekenhuis, Baylor College of Medicine, University of Cagliari, Duke University, Duke Medical Center, Beth Israel Deaconess Medical Center, Wright State University, Valencian Infertility Institute, University of Florence, University College Hospital
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2754857754