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CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(12): 911-918
DOI: 10.1055/s-0041-1740271
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Diagnosing Septate Uterus Using Three-Dimensional Ultrasound Using Three Different Classifications: An Interobserver and Intraobserver Agreement Study

Diagnóstico de útero septado com ecografia tridimensional usando três classificações diferentes: Um estudo de concordância interobservador e intraobservador
Carla Peixoto 
1   Department of Obstetrics and Gynecology, Centro Hospitalar São João, Porto, Portugal
2   Faculty of Medicine, University of Porto, Porto, Portugal
,
Maite Castro 
3   Centro de Infertilidad y Reproduccion Humana, Barcelona, Spain
,
Isabel Carriles 
4   Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
,
Maria de Arriba 
5   Department of Obstetrics and Gynecology, University and Polytechnic Hospital La Fe, Valencia, Spain
,
Victoria Lapresa 
6   Department of Obstetrics and Gynecology, University Hospital, Salamanca, Spain
,
Juan Luis Alcazar 
4   Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
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Abstract

Objective Currently, there are up to three different classifications for diagnosing septate uterus. The interobserver agreement among them has been poorly assessed.

Objective 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.

Methods 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.

Results 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.

Conclusion 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.

Resumo

Objetivo Atualmente, existem até três classificações diferentes para o diagnóstico de útero septado. A concordância interobservador entre eles tem sido pouco avaliada.

Objetivo Avaliar a concordância interobservador de ecografistas não especialistas para classificar úteros septados usando as classificações European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE, na sigla em inglês), American Society for Reproductive Medicine (ASRM, na sigla em inglês) e Congenital Uterine Malformations by Experts (CUME, na sigla em inglês).

Métodos Foram utilizados 50 volumes tridimensionais (3D) de uma série não consecutiva de mulheres com suspeita de malformação uterina. Dois examinadores não especialistas avaliaram um único volume 3D do útero de cada mulher, mutuamente cegos. As seguintes medidas foram aferidas: profundidade de indentação, ângulo de indentação, espessura da parede do fundo uterino, indentação externa do fundo e relação entre indentação e a espessura da parede (I:WT, na sigla em inglês). Cada observador teve que atribuir um diagnóstico em cada caso, de acordo com os três sistemas de classificação (ESHRE/ESGE, ASRM e CUME). A concordância interobservador em relação às classificações ESHRE/ESGE, ASRM e CUME foi avaliada usando o índice kappa ponderado de Cohen (k). A concordância em relação às três classificações (ASRM versus ESHRE-ESGE, ASRM versus CUME e ESHRE-ESGE versus CUME) também foi avaliada.

Resultados A concordância interobservador entre os 2 examinadores não especialistas foi boa para a classificação ESHRE/ESGE (k = 0,74, intervalo de confiança [IC] 95%: 0,55–0,92) e muito boa para os sistemas de classificação ASRM e CUME (k = 0,95; IC 95%: 0,86–1,00; e k = 0,91; IC95%: 0,79–1,00, respectivamente). A concordância entre as classificações ESHRE/ESGE e ASRM foi moderada para ambos os examinadores. A concordância entre as classificações ESHRE/ESGE e CUME foi moderada para o examinador 1 e boa para o examinador 2. A concordância entre as classificações ASRM e CUME foi boa para ambos os examinadores.

Conclusão As três classificações apresentam concordância interobservador boa (ESHRE/ESGE) ou muito boa (ASRM e CUME). A concordância entre as classificações ASRM e CUME foi maior do que entre as classificações ESHRE/ESGE e ASRM e ESHRE/ESGE e CUME.

Keywords

uterus - ultrasonography - congenital anomaly

Palavras-chave

útero - ecografia - anomalia congênita


Publication History

Received: 07 August 2020

Accepted: 13 October 2021

Article published online:
21 December 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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