PMID- 29024135
OWN - NLM
STAT- MEDLINE
DCOM- 20180918
LR  - 20180918
IS  - 1469-0705 (Electronic)
IS  - 0960-7692 (Linking)
VI  - 51
IP  - 1
DP  - 2018 Jan
TI  - Congenital Uterine Malformation by Experts (CUME): better criteria for
      distinguishing between normal/arcuate and septate uterus?
PG  - 101-109
LID - 10.1002/uog.18923 [doi]
AB  - 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's 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 < 90 degrees ), 82 normal/arcuate (depth < 10 mm and angle > 90 degrees )
      and 13 uteri that could not be classified (referred to as the gray-zone). The
      agreement between ESHRE-ESGE and CUME was 38% (kappa, 0.1); the agreement between
      ASRM criteria and CUME for septate was 87% (kappa, 0.39), and considering both
      septate and gray-zone as septate, the agreement was 98% (kappa, 0.93). Among the 
      three measurements, the interobserver reproducibility of indentation depth (CCC, 
      0.99; 95% CI, 0.98-0.99) was better than both indentation angle (CCC, 0.96; 95%
      CI, 0.94-0.97) and I:WT ratio (CCC, 0.92; 95% CI, 0.90-0.94). The diagnostic test
      accuracy of these three measurements using CUME as reference standard was very
      good, with AUC between 0.96 and 1.00. The best cut-off values for these
      measurements to define septate uterus were: indentation depth >/= 10 mm,
      indentation angle < 140 degrees and I:WT ratio > 110% . CONCLUSIONS: The
      suggested ESHRE-ESGE cut-off value overestimates the prevalence of septate uterus
      while that of ASRM underestimates this prevalence, leaving in the gray-zone most 
      of the uteri that experts considered as septate. We recommend considering
      indentation depth >/= 10 mm as septate, since the measurement is simple and
      reliable and this criterion is in agreement with expert opinion. Copyright (c)
      2017 ISUOG. Published by John Wiley & Sons Ltd.
CI  - Copyright (c) 2017 ISUOG. Published by John Wiley & Sons Ltd.
FAU - Ludwin, A
AU  - Ludwin A
AUID- ORCID: 0000-0001-5853-8661
AD  - Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.
AD  - Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland.
FAU - Martins, W P
AU  - Martins WP
AD  - SEMEAR Fertilidade, Reproductive Medicine, Ribeirao Preto, Brazil.
AD  - Department of Obstetrics and Gynecology, Faculty of Medicine of Ribeirao Preto,
      University of Sao Paulo (DGO-FRMP-USP), Ribeirao Preto, Brazil.
FAU - Nastri, C O
AU  - Nastri CO
AD  - Department of Obstetrics and Gynecology, Faculty of Medicine of Ribeirao Preto,
      University of Sao Paulo (DGO-FRMP-USP), Ribeirao Preto, Brazil.
FAU - Ludwin, I
AU  - Ludwin I
AD  - Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.
AD  - Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland.
FAU - Coelho Neto, M A
AU  - Coelho Neto MA
AD  - SEMEAR Fertilidade, Reproductive Medicine, Ribeirao Preto, Brazil.
FAU - Leitao, V M
AU  - Leitao VM
AD  - SEMEAR Fertilidade, Reproductive Medicine, Ribeirao Preto, Brazil.
FAU - Acien, M
AU  - Acien M
AD  - San Juan University Hospital/Miguel Hernandez University, Alicante, Spain.
FAU - Alcazar, J L
AU  - Alcazar JL
AUID- ORCID: 0000-0002-9700-0853
AD  - Department of Obstetrics and Gynecology, University of Navarra, Pamplona, Spain.
FAU - Benacerraf, B
AU  - Benacerraf B
AD  - Harvard Medical School, Boston, MA, USA.
FAU - Condous, G
AU  - Condous G
AD  - Obstetrics and Gynaecology, Acute Gynaecology, Early Pregnancy and Advanced
      Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean, University of
      Sydney, Sydney, NSW, Australia.
FAU - De Wilde, R-L
AU  - De Wilde RL
AD  - Carl-von-Ossietzky-University Oldenburg, Oldenburg, Germany.
FAU - Emanuel, M H
AU  - Emanuel MH
AD  - University Medical Center Utrecht, Utrecht, The Netherlands.
AD  - University Hospital Ghent, Ghent, Belgium.
FAU - Gibbons, W
AU  - Gibbons W
AD  - Baylor College of Medicine, Houston, TX, USA.
FAU - Guerriero, S
AU  - Guerriero S
AUID- ORCID: 0000-0002-1359-7155
AD  - Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy.
FAU - Hurd, W W
AU  - Hurd WW
AD  - Division of Reproductive Endocrinology and Infertility, Department of Obstetrics 
      and Gynecology, Duke University Medical Center, Durham, NC, USA.
FAU - Levine, D
AU  - Levine D
AD  - Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
FAU - Lindheim, S
AU  - Lindheim S
AD  - Department of Obstetrics & Gynecology, Wright State University, Boonshoft School 
      of Medicine, Dayton, OH, USA.
FAU - Pellicer, A
AU  - Pellicer A
AD  - Instituto Valenciano de Infertilidad, Valencia, Spain.
FAU - Petraglia, F
AU  - Petraglia F
AD  - University of Florence, Florence, Italy.
FAU - Saridogan, E
AU  - Saridogan E
AD  - University College London Hospital, London, UK.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Ultrasound Obstet Gynecol
JT  - Ultrasound in obstetrics & gynecology : the official journal of the International
      Society of Ultrasound in Obstetrics and Gynecology
JID - 9108340
RN  - Uterine Anomalies
SB  - IM
EIN - Ultrasound Obstet Gynecol. 2018 Feb;51(2):282. PMID: 29417681
MH  - Abortion, Spontaneous/*prevention & control
MH  - Adult
MH  - Female
MH  - Humans
MH  - Hysteroscopy
MH  - Pregnancy
MH  - Prospective Studies
MH  - Reference Standards
MH  - *Reproductive Medicine
MH  - *Ultrasonography
MH  - Urogenital Abnormalities/*diagnostic imaging/physiopathology
MH  - Uterine Diseases/*diagnostic imaging/physiopathology
MH  - Uterus/*abnormalities/diagnostic imaging/physiopathology
OTO - NOTNLM
OT  - *Mullerian ducts
OT  - *agreement
OT  - *congenital uterine anomalies
OT  - *uterine septum
EDAT- 2017/10/13 06:00
MHDA- 2018/09/19 06:00
CRDT- 2017/10/13 06:00
PHST- 2017/06/28 00:00 [received]
PHST- 2017/08/26 00:00 [revised]
PHST- 2017/09/28 00:00 [accepted]
PHST- 2017/10/13 06:00 [pubmed]
PHST- 2018/09/19 06:00 [medline]
PHST- 2017/10/13 06:00 [entrez]
AID - 10.1002/uog.18923 [doi]
PST - ppublish
SO  - Ultrasound Obstet Gynecol. 2018 Jan;51(1):101-109. doi: 10.1002/uog.18923.