Skip to main content
SpringerLink
Log in

Classification of Uterine Anomalies by 3-Dimensional Ultrasonography Using ESHRE/ESGE Criteria: Interobserver Variability

  • Original Article
  • Published:
Reproductive Sciences Aims and scope Submit manuscript

Abstract

Objective

To evaluate the interobserver repeatability of the coronal view measurements and classification of the uterine malformations (UM) according to the ESHRE/ESGE consensus by transvaginal three-dimensional ultrasound (3D-US).

Methods

89 transvaginal 3D-US volumes acquired during the last two years at Delta Ecografia in Madrid, Spain, were selected from our archive by convenience sampling. Two expert operators blinded from each other, performed post-hoc analysis using render mode and multiplanar-Volume Contrast Imaging (VCI) navigation. Uterine wall thickness at the fundus, indentation of the cavity and indentation of the fundus were measured, classified and sub-classified following the recommendations of the ESHRE/ESGE consensus. The reproducibility of interobserver measurements and classification was examined by calculating intraclass correlation coefficients (ICC) and their 95% confidence intervals (CI) and kappa statistic (k).

Results

Repeatability in the measurements: uterine wall thickness: ICC = 0.93 (95% CI, 0.90–0.96), P < 0.0001; indentation of the cavity: ICC = 0.93 (95% CI, 0.86-0.96), P < 0.0001; indentation of the fundus: ICC = 0.93 (95% CI, 0.90–0.96), P < 0.0001. Level of agreement in the classification: overall (U0, UI, U2, U3, U4, U5): k = 0.73 (95% CI, 0.61–0.84), P > 0.0001; U2 (U2a, U2b): k = 0.56 (95% CI, 0.31–0.80), P < 0.001 (0.78 observed agreement compared to 0.49 expected); U3 (U3a, U3b, U3c): k = 0.69 (95% CI, 0.16-1.00), P < 0.05 (0.85 observed agreement compared to 0.53 expected); U4 (U4a, U4b): k = 1.00 (95% CI, 1.00–1.00), P < 0.0001.

Conclusions

Transvaginal 3D-US examination of the uterus allows assessment and classification of the UM by the ESHRE/ESGE criteria showing a good interobserver repeatability and reproducibility in most cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Grimbizis GF, Di Spiezio Sardo A, Saravelos SH, et al. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod. 2016;13(1):2–7.

    Article  Google Scholar 

  2. Bermejo C, Martinez Ten P, Cantarero R, et al. Threedimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet Gynecol. 2010;35(5):593–601.

    Article  CAS  PubMed  Google Scholar 

  3. Bermejo C, Martinez-Ten P, Recio M, et al. Three-dimensional ultrasound and magnetic resonance imaging assessment of cervix and vagina in women with uterine malformations. Ultrasound Obstet Gynecol. 2014;43(3):336–345.

    Article  CAS  PubMed  Google Scholar 

  4. Grimbizis G, Gordts S, Di SpiezoSardo A, et al. The ESHRE/ ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 2013;28(8):2032–2044.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Lantz CA, Nebenzahl E. Behavior and interpretation of the k statistic: resolution of the two paradoxes. J Clin Epidemiol. 1996;49(4):431–434.

    Article  CAS  PubMed  Google Scholar 

  6. Bland JM, Altaian DG. Statistical methods for assessing agree-ment between two methods of clinical measurement. Lancet. 1986;1(8476):307–310.

    Article  CAS  Google Scholar 

  7. The American Fertility Society. The American Fertility Society classifications of adnexal adhesions, distal tubal obstruction, tubal occlusion secondary to tubal ligation, tubal pregnancies, Muller-ian anomalies and intrauterine adhesions. Fertil Steril. 1988; 49(6):944–955.

    Article  Google Scholar 

  8. Di Spiezio Sardo A, Campo R, Gordts S, et al. The comprehen-siveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system. Human Reprod. 2015;30(5): 1046–1058

    Article  Google Scholar 

  9. Acien P, Acien M. Diagnostic imaging and cataloguing of female genital malformations. Insights Imaging. 2016;7(5):713–726.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Graupera B, Pascual MA, Hereter L, et al. Accuracy of three-dimensional ultrasound compared with magnetic resonance imaging in diagnosis of Mullerian duct anomalies using ESHRE-ESGE consensus on the classification of congenital anomalies of the female genital tract. Ultrasound Obstet Gynecol. 2015;46(5): 616–622.

    Article  CAS  PubMed  Google Scholar 

  11. Ludwin A, Ludwin I. Comparison of the ESHRE-ESGE and ASRM classifications of Mullerian duct anomalies in everyday practice. Hum Reprod. 2016;30(3):569–580.

    Article  Google Scholar 

  12. Practice Committee of the American Society for Reproductive Medicine. American Society for Reproductive Medicine, Birmingham, Alabama. Uterine septum: a guideline. Fertil Steril. 2016;3(3):530–540.

    Google Scholar 

  13. Veneris C, Papadopoulos S, Campo R, Gordts S, Tarlatzis B, Grimbizis G. Clinical implications of congenital uterine anoma-lies: a meta-analysis of comparative studies. BioMedicine Online. 2014;29(6):665–683.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Delta Ecografía, Centro de Diagnóstico por la Imagen en Obstetricia, Ginecología y Mama, Calle del Conde de Peñalver, 14, Escderecha, 1° izquierda, 28006, Madrid, Spain

    C. Bermejo MD, PhD, P. Marínez-Ten MD, PhD, M. Estévez MD & M. M. Gil MD, PhD

  2. Gerencia de Atención Primaria de Toledo, SESCAM, Toledo, Spain

    L. Ruíz-López BA

  3. Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain

    M. M. Gil MD, PhD

  4. Universidad Francisco de Vitoria, Carretera de Pozuelo a Majadahonda Km 1800, Pozuelo de Alarcón, Madrid, Spain

    M. M. Gil MD, PhD

Authors
  1. C. Bermejo MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Marínez-Ten MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Ruíz-López BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Estévez MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. M. Gil MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Bermejo MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bermejo, C., Marínez-Ten, P., Ruíz-López, L. et al. Classification of Uterine Anomalies by 3-Dimensional Ultrasonography Using ESHRE/ESGE Criteria: Interobserver Variability. Reprod. Sci. 25, 740–747 (2018). https://doi.org/10.1177/1933719117725825

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1177/1933719117725825

Keywords

Search

Navigation