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The Rule of 10: a simple 3D ultrasonographic method for the diagnosis of T-shaped uterus

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To investigate and propose a new simple tridimensional (3D) ultrasonographic method to diagnose a T-shaped uterus (Class U1a).

Methods

A multicenter non-experimental case–control diagnostic accuracy study was conducted between January 2018 and December 2019, including 50 women (cases) diagnosed with T-shaped uterus (U1a class) and 50 women with a “normal uterus” (controls). All the enrolled women underwent 3D ultrasound, drawing four lines and recording the length of three of them as follow: draw and measure the interostial line (R0); draw from the midpoint of R0 a perpendicular line length 20 mm; draw and measure in the uterine cavity a line parallel to R0 at 10 mm below R0 (R10) and a second line parallel to R0 at 20 mm below R0 (R20). The diagnostic performance of all sonographic parameters statistically significantly different between T-shaped and normal uteri was estimated using the receiver operator characteristic (ROC) curve analysis.

Results

R10 and R20 were statistically significantly shorter in the T-shaped than the normal uterus. R10 reported the highest diagnostic accuracy with an area under the ROC curve of 0.973 (95% CI 0.940–1.000). R10 length maximizing the Youden’s J statistic was 10.5 mm. Assuming R10 length equal to or shorter than 10 mm as the cut off value for defining a woman as having a T-shaped uterus, the new ultrasonographic method following the proposed protocol (R0, R10, and R20) reported sensitivity for T-shaped uterus of 91.1% (95% CI 0.78–0.97%) and a specificity of 100% (95% CI 0.89–100%). The positive likelihood ratio was higher than 30, and the negative likelihood ratio was 0.09 (95% CI 0.04–0.26).

Conclusions

Measuring the length of the intracavitary line parallel to the interostial line at 10 mm from it and using a length ≤ of 10 mm as cut off value (the “Rule of 10”) appears a simple and accurate 3D ultrasonographic method for the diagnosis of a T-shaped uterus.

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All data are fully available without restriction within the manuscript.

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Funding

The study was not funded.

Author information

Authors and Affiliations

  1. Reproductive Surgery Unit, Centro Gutenberg, Malaga, Spain

    Luis Alonso Pacheco & Pedro Azumendi Gómez

  2. Delta Ecografía, Madrid, Spain

    Carmina Bermejo López & Pilar Martinez-Ten

  3. Miller School of Medicine, Obstetrics and Gynecology Department, University of Miami, Miami, FL, USA

    José Carugno

  4. Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy

    Antonio Simone Laganà

  5. Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy

    Simone Garzon

Authors
  1. Luis Alonso Pacheco
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  2. Carmina Bermejo López
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  3. José Carugno
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  4. Pedro Azumendi Gómez
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  5. Pilar Martinez-Ten
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  6. Antonio Simone Laganà
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  7. Simone Garzon
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Contributions

All the authors conform to the International Committee of Medical Journal Editors (ICMJE) criteria for authorship, contributed to the intellectual content of the study, and approved the final version of the article. LAP, CB, and JC conceptualized the study. LAP, SG, and ASL designed the study. LAP, CB, JC, PA, and PM-T performed the measures and collected the data. SG and LAP managed the data set and performed statistical analyses. LAP, CB, SG, ASL wrote the manuscript. All authors contributed to the interpretation of the results, as well as to the writing and editing of the manuscript.

Corresponding author

Correspondence to Antonio Simone Laganà.

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Conflict of interest

All the authors have no conflict of interest to declare.

Ethics approval

All the design, analysis, interpretation of data, drafting, and revisions conform to the Helsinki Declaration, the Committee on Publication Ethics (COPE) guidelines (http://publicationethics.org/), and the STARD (Standards for Reporting Diagnostic accuracy studies) statement, available through the EQUATOR (enhancing the quality and transparency of health research) network (www.equator-network.org). The study was approved by the Institutional Review Board (IRB) of the two study centers (approval ID: GUT-12019).

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Alonso Pacheco, L., Bermejo López, C., Carugno, J. et al. The Rule of 10: a simple 3D ultrasonographic method for the diagnosis of T-shaped uterus. Arch Gynecol Obstet 304, 1213–1220 (2021). https://doi.org/10.1007/s00404-021-06147-y

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  • DOI: https://doi.org/10.1007/s00404-021-06147-y

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