Congenital Uterine Malformation by Experts (CUME): better criteria for distinguishing between normal/arcuate and septate uterus?. Ultrasound Obstet Gynecol, 51(1):101-109, 2018 01, 2018.
abstract   bibtex   
OBJECTIVES: To assess the level of agreement between experts in distinguishing between septate and normal/arcuate uterus using their subjective judgment when reviewing the coronal view of the uterus from three-dimensional ultrasound. Another aim was to determine the interobserver reliability and diagnostic test accuracy of three measurements suggested by recent guidelines, using as reference standard the decision made most often by experts (Congenital Uterine Malformation by Experts (CUME)). METHODS: Images of the coronal plane of the uterus from 100 women with suspected fundal internal indentation were anonymized and provided to 15 experts (five clinicians, five surgeons and five sonologists). They were instructed to indicate whether they believed the uterus to be normal/arcuate (defined as normal uterine morphology or not clinically relevant degree of distortion caused by internal indentation) or septate (clinically relevant degree of distortion caused by internal indentation). Two other observers independently measured indentation depth, indentation angle and indentation-to-wall-thickness (I:WT) ratio. The agreement between experts was assessed using kappa, the interobserver reliability was assessed using the concordance correlation coefficient (CCC), the diagnostic test accuracy was assessed using the area under the receiver-operating characteristics curve (AUC) and the best cut-off value was assessed using Youden\textquoterights index, considering as the reference standard the choice made most often by the experts (CUME). RESULTS: There was good agreement between all experts (kappa, 0.62). There were 18 septate and 82 normal/arcuate uteri according to CUME; European Society of Human Reproduction and Embryology (ESHRE)-European Society for Gynaecological Endoscopy (ESGE) criteria (I:WT ratio > 50%) defined 80 septate and 20 normal/arcuate uteri, while American Society for Reproductive Medicine (ASRM) criteria defined five septate (depth > 15 mm and angle , keywords = Abortion, Spontaneous, Adult, Female, Humans, Hysteroscopy, Pregnancy, Prospective Studies, Reference Standards, Reproductive Medicine, Ultrasonography, Urogenital Abnormalities, Uterine Diseases, Uterus, issn = 1469-0705, doi = 10.1002/uog.18923, author = Ludwin, A and Martins, W P and Nastri, C O and Ludwin, I and Coelho Neto, M A and Leitão, V M and Acién, M and Alcazar, J L and Benacerraf, B and Condous, G and De Wilde, R-L and Emanuel, M H and Gibbons, W and Guerriero, S and Hurd, W W and D. Levine and Lindheim, S and Pellicer, A and Petraglia, F and Saridogan, E

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