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

• DOI: 10.1002/uog.18923
• Publication Date: 2017-10-11T13:42:42Z
• Authors: A. Ludwin; W. P. Martins; C. O. Nastri; I. Ludwin; M. A. Coelho Neto; V. M. Leitão; M. Acién; J. L. Alcazar; B. Benacerraf; G. Condous; R.‐L. De Wilde; M. H. Emanuel; W. Gibbons; S. Guerriero; W. W. Hurd; D. Levine; S. Lindheim; A. Pellicer; F. Petraglia; E. Saridogan
• Keywords: Septate

ABSTRACT Objectives To assess the level of agreement between experts in distinguishing septate and normal/arcuate uterus using their subjective judgment when reviewing coronal view from three‐dimensional ultrasound. Another aim was to determine interobserver reliability diagnostic test accuracy three measurements suggested by recent guidelines, as reference standard decision made most often (Congenital Uterine Malformation Experts (CUME)). Methods Images plane 100 women with suspected fundal internal indentation were anonymized provided 15 (five clinicians, five surgeons sonologists). They instructed indicate whether they believed be (defined normal uterine morphology or not clinically relevant degree distortion caused indentation) (clinically indentation). Two other observers independently measured depth, angle indentation‐to‐wall‐thickness (I:WT) ratio. The assessed kappa, concordance correlation coefficient (CCC), area under receiver–operating characteristics curve (AUC) best cut‐off value Youden's index, considering choice (CUME). Results There good all (kappa, 0.62). 18 82 uteri according CUME; European Society Human Reproduction Embryology (ESHRE)‐European for Gynaecological Endoscopy (ESGE) criteria (I:WT ratio > 50%) defined 80 20 uteri, while American Reproductive Medicine (ASRM) (depth mm < 90°), 10 90°) 13 that could classified (referred gray‐zone). ESHRE‐ESGE CUME 38% 0.1); ASRM 87% 0.39), both gray‐zone septate, 98% 0.93). Among measurements, reproducibility depth (CCC, 0.99; 95% CI, 0.98–0.99) better than 0.96; 0.94–0.97) I:WT 0.92; 0.90–0.94). these very good, AUC 0.96 1.00. values define were: ≥ mm, 140° 110% . Conclusions overestimates prevalence underestimates this prevalence, leaving considered septate. We recommend since measurement is simple reliable criterion expert opinion. Copyright © 2017 ISUOG. Published John Wiley & Sons Ltd.