scholarly journals Diagnosing Septate Uterus Using Three-Dimensional Ultrasound Using Three Different Classifications: An Interobserver and Intraobserver Agreement Study

2021 ◽  
Vol 43 (12) ◽  
pp. 911-918
Author(s):  
Carla Peixoto ◽  
Maite Castro ◽  
Isabel Carriles ◽  
Maria de Arriba ◽  
Victoria Lapresa ◽  
...  
Keyword(s):  
Wall Thickness ◽  
European Society ◽  
Interobserver Agreement ◽  
Three Dimensional ◽  
Classification Systems ◽  
Human Reproduction ◽  
Kappa Index ◽  
Septate Uterus ◽  
Uterine Malformation ◽  
Good For

Abstract Objective Currently, there are up to three different classifications for diagnosing septate uterus. The interobserver agreement among them has been poorly assessed. Objective To assess the interobserver agreement of nonexpert sonographers for classifying septate uterus using the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), American Society for Reproductive Medicine (ASRM), and Congenital Uterine Malformations by Experts (CUME) classifications. Methods A total of 50 three-dimensional (3D) volumes of a nonconsecutive series of women with suspected uterine malformation were used. Two nonexpert examiners evaluated a single 3D volume of the uterus of each woman, blinded to each other. The following measurements were performed: indentation depth, indentation angle, uterine fundal wall thickness, external fundal indentation, and indentation-to-wall-thickness (I:WT) ratio. Each observer had to assign a diagnosis in each case, according to the three classification systems (ESHRE/ESGE, ASRM, and CUME). The interobserver agreement regarding the ESHRE/ESGE, ASRM, and CUME classifications was assessed using the Cohen weighted kappa index (k). Agreement regarding the three classifications (ASRM versus ESHRE/ESGE, ASRM versus CUME, ESHRE/ESGE versus CUME) was also assessed. Results The interobserver agreement between the 2 nonexpert examiners was good for the ESHRE/ESGE (k = 0.74; 95% confidence interval [CI]: 0.55–0.92) and very good for the ASRM and CUME classification systems (k = 0.95; 95%CI: 0.86–1.00; and k = 0.91; 95%CI: 0.79–1.00, respectively). Agreement between the ESHRE/ESGE and ASRM classifications was moderate for both examiners. Agreement between the ESHRE/ESGE and CUME classifications was moderate for examiner 1 and good for examiner 2. Agreement between the ASRM and CUME classifications was good for both examiners. Conclusion The three classifications have good (ESHRE/ESGE) or very good (ASRM and CUME) interobserver agreement. Agreement between the ASRM and CUME classifications was higher than that for the ESHRE/ESGE and ASRM and ESHRE/ESGE and CUME classifications.

scholarly journals Uterine Fundus Remodeling after Hysteroscopic Metroplasty: A Prospective Pilot Study

2021 ◽  
Vol 10 (2) ◽  
pp. 260
Author(s):  
Paolo Casadio ◽  
Giulia Magnarelli ◽  
Mariangela La Rosa ◽  
Andrea Alletto ◽  
Alessandro Arena ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Transvaginal Ultrasound ◽  
Three Dimensional ◽  
Second Step ◽  
Septate Uterus ◽  
Uterine Malformation ◽  
Uterine Septum ◽  
Uterine Fundus ◽  
Congenital Uterine Malformation

The septate uterus is the most common congenital uterine malformation and is treated by hysteroscopic metroplasty. There are few studies on the fundal uterine changes that occur after surgery. We designed a pilot prospective observational study to evaluate by three-dimensional transvaginal ultrasound (3D-TVS) the changes not only of the internal fundal uterine profile, but also of the external one, after hysteroscopic metroplasty. Sixty women who underwent hysteroscopic metroplasty for partial or complete uterine septum (U2a and U2b subclasses of ESHRE/ESGE classification) were enrolled. We performed 3D-TVS after surgery confirming optimal removal of the septum. However, at ultrasound follow-up after three months, we observed a significant increase (p < 0.001) in the residual septum (Zr) (3.7 mm (95% CI: 3.1–4.4)), the myometrial wall thickness (Y) (2.5 mm (95% CI: 2.0–3.0)) and the total fundal wall thickness (Y + Zr) (6.2 mm (95% CI: 5.5–6.9)). Forty-three patients (72%) required a second step of hysteroscopic metroplasty. Moreover, the shape of uterine fundus changed in 58% of cases. We actually observed a remodeling of the uterine fundus with modifications of its external and internal profiles. Therefore, we propose to always perform a second ultrasound look at least three months after the metroplasty to identify cases that require a second- step metroplasty.

scholarly journals Three-dimensional Ultrasonography in the Diagnosis of Müllerian Duct Anomalies

2009 ◽  
Vol 3 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Carmina Bermejo ◽  
Rocío Cantarero ◽  
Dolores Díaz ◽  
Eva Labrador ◽  
Laura Ruiz López
Keyword(s):  
Mr Imaging ◽  
Three Dimensional ◽  
Uterine Cavity ◽  
Kappa Index ◽  
Septate Uterus ◽  
Imperforate Hymen ◽  
Bicornuate Uterus ◽  
Uterine Malformation ◽  
Uterine Malformations ◽  
3D Ultrasonography

Abstract Aims We studied the effectiveness of three-dimensional (3D) ultrasonography in the diagnosis of uterine malformations. Methods 175 patients with clinical or ultrasonographic suspicion of uterine malformation were studied between November 2004 and June 2008. In all women we measured uterine volume for processing and later reconstruction of 3D images. Cases in which no anomaly was detected with the 3D technique were excluded from study. A thorough physical genital examination with speculum was done before or after ultrasonography, except in three women with an imperforate hymen. Uterine malformations were recorded in detail, and the findings were catalogued according to the American Fertility Society (AFS) classification. In 32 women magnetic resonance (MR) imaging was also used, and agreement between the two techniques was calculated with the kappa index. Results The 175 müllerian anomalies we analyzed were diagnosed as agenesis (1 case), unicornuate uterus (1 genuine, 1 communicating), didelphys uterus (4), bicornuate uterus (22), septate uterus (80, 8 with two cervices) and arcuate uterus (68). For 1 unicornuate, 3 bicornuate, 25 septate (4 with two cervices) and 3 arcuate uteri we performed MR imaging. Diagnostic correlation between 3D ultrasonography and MR imaging was obtained in all cases according to the AFS classification (kappa = 100%); concordance was also seen for descriptions of associated uterine malformations except for two cases: 1 bicornuate uterus with the additional presence of a cervical septum as detected by MR imaging, which was not found on hysteroscopy for resection, and 1 septate uterus that appeared to have two cervices on 3D ultrasonography in a patient in whom physical examination was not possible, and in whom MR imaging showed a complete septum with hypointense signals (kappa = 93.45%; 95% confidence interval 80.75- 100%). Discussion Owing to its ability to clearly render contours of anatomical structures, 3D ultrasonography provides detailed images of uterine malformations and yields very similar results to those obtained with MR imaging. For an accurate comparison of the two techniques, ultrasonography should be accompanied by gynecologic physical exploration, since the two methods yield equivalent results for the relation between the uterine cavity and the fundus. MR imaging is especially useful to evaluate the cervix and vagina.

Interobserver Agreement in the Study of 2D and 3D Sonographic Criteria for Adenomyosis

2017 ◽  
Vol 9 (3) ◽  
pp. 211-215 ◽  
Author(s):  
José M. Puente ◽  
Juan L. Alcazar ◽  
Pilar Martinez-Ten ◽  
Carmina Bermejo ◽  
María T. Troncoso ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Transvaginal Ultrasound ◽  
Three Dimensional ◽  
Kappa Index ◽  
Junctional Zone ◽  
Experienced Observer ◽  
3D Sonography ◽  
2D And 3D ◽  
Very High ◽  
Good Agreement

Objective To study the degree of interobserver agreement for already known two-dimensional (2D) and three-dimensional (3D) sonography criteria of adenomyosis. Methods Fifty cases (25 adenomyosis cases, 25 non-adenomyosis cases) were studied by four expert observers and a less-experienced researcher. Each sonographic adenomyosis criterion was separately studied. Interobserver agreement was analysed by the kappa index with 95% confidence interval (CI). Results The degree of agreement about diagnosing adenomyosis was high or very high in all pair-wise comparisons (kappa values of 0.58–0–92). The agreement on identifying intra-myometrial cysts (kappa values of 0.46–0.79) and evaluating the junctional zone (JZ) by 3D-transvaginal ultrasound (3D-TVS) (kappa index of 0.46–0.88) was good. The agreements reached when evaluating the other criteria varied, but good agreement was generally reached. Conclusions Both the 2D-TVS and 3D-TVS criteria employed in diagnosing adenomyosis were reproducible parameters in adenomyosis diagnostics. The results were reproducible, even by a less experienced observer.

scholarly journals Inappropriate surgery in a patient with misdiagnosed Robert’s uterus

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Iori Kisu ◽  
Kanako Nakamura ◽  
Tetsuro Shiraishi ◽  
Tomoko Iijima ◽  
Moito Iijima ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Uterine Wall ◽  
Septate Uterus ◽  
Case Presentation ◽  
Surgical Interventions ◽  
Unicornuate Uterus ◽  
Uterine Malformation ◽  
Mullerian Anomaly ◽  
Future Pregnancy

Abstract Background Robert’s uterus is a rare Mullerian anomaly, which can be described as an asymmetric, septate uterus with a non-communicating hemicavity. Herein, we present the case of a misdiagnosed Robert’s uterus, resulting in an invasive and disadvantageous surgery. Case presentation A 16-year-old woman was referred to our department because of dysmenorrhea and suspicion of uterine malformation. We misdiagnosed Robert’s uterus as a unicornuate uterus with a non-communicating rudimentary horn and hematometra, and performed laparoscopic hemi-hysterectomy. Although the patient’s symptoms were relieved, our surgical procedure left the lateral uterine wall weak, making the patient’s uterus susceptible to uterine rupture in any future pregnancy. Conclusions Although the early diagnosis of Robert’s uterus is challenging, it is important in order to determine appropriate surgical interventions and management for maintaining the quality of life and ensuring safety in future pregnancies.

scholarly journals Interobserver agreement of the Paris and simplified classifications of superficial colonic lesions: a Western study

2021 ◽  
Vol 09 (03) ◽  
pp. E388-E394
Author(s):  
Francesco Cocomazzi ◽  
Marco Gentile ◽  
Francesco Perri ◽  
Antonio Merla ◽  
Fabrizio Bossa ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Classification Systems ◽  
Sensitivity Analyses ◽  
Size Estimation ◽  
Rater Agreement ◽  
Staff Members ◽  
Video Clips ◽  
Paris Classification ◽  
Level Of Agreement

Abstract Background and study aims The Paris classification of superficial colonic lesions has been widely adopted, but a simplified description that subgroups the shape into pedunculated, sessile/flat and depressed lesions has been proposed recently. The aim of this study was to evaluate the accuracy and inter-rater agreement among 13 Western endoscopists for the two classification systems. Methods Seventy video clips of superficial colonic lesions were classified according to the two classifications, and their size estimated. The interobserver agreement for each classification was assessed using both Cohen k and AC1 statistics. Accuracy was taken as the concordance between the standard morphology definition and that made by participants. Sensitivity analyses investigated agreement between trainees (T) and staff members (SM), simple or mixed lesions, distinct lesion phenotypes, and for laterally spreading tumors (LSTs). Results Overall, the interobserver agreement for the Paris classification was substantial (κ = 0.61; AC1 = 0.66), with 79.3 % accuracy. Between SM and T, the values were superimposable. For size estimation, the agreement was 0.48 by the κ-value, and 0.50 by AC1. For single or mixed lesions, κ-values were 0.60 and 0.43, respectively; corresponding AC1 values were 0.68 and 0.57. Evaluating the several different polyp subtypes separately, agreement differed significantly when analyzed by the k-statistics (0.08–0.12) or the AC1 statistics (0.59–0.71). Analyses of LSTs provided a κ-value of 0.50 and an AC1 score of 0.62, with 77.6 % accuracy. The simplified classification outperformed the Paris classification: κ = 0.68, AC1 = 0.82, accuracy = 91.6 %. Conclusions Agreement is often measured with Cohen’s κ, but we documented higher levels of agreement when analyzed with the AC1 statistic. The level of agreement was substantial for the Paris classification, and almost perfect for the simplified system.

P11.08: Three-dimensional ultrasound in diagnosis of septate uterus in patients with suspected congenital uterine anomalies

2010 ◽  
Vol 36 (S1) ◽  
pp. 210-210
Author(s):  
B. Graupera ◽  
M. Pascual ◽  
B. Úbeda ◽  
L. Hereter ◽  
C. Pedrero ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Septate Uterus ◽  
Uterine Anomalies

Simple Rules, Not So Simple: The Use of International Ovarian Tumor Analysis (IOTA) Terminology and Simple Rules in Inexperienced Hands in a Prospective Multicenter Cohort Study

2017 ◽  
Vol 38 (06) ◽  
pp. 633-641 ◽  
Author(s):  
Evelyne Meys ◽  
Iris Rutten ◽  
Roy Kruitwagen ◽  
Brigitte Slangen ◽  
Sandrina Lambrechts ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ovarian Tumor ◽  
Interobserver Agreement ◽  
Tumor Type ◽  
Kappa Index ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Simple Rules ◽  
Level Of Agreement ◽  
Ovarian Masses

Abstract Objectives To analyze how well untrained examiners – without experience in the use of International Ovarian Tumor Analysis (IOTA) terminology or simple ultrasound-based rules (simple rules) – are able to apply IOTA terminology and simple rules and to assess the level of agreement between non-experts and an expert. Methods This prospective multicenter cohort study enrolled women with ovarian masses. Ultrasound was performed by non-expert examiners and an expert. Ultrasound features were recorded using IOTA nomenclature, and used for classifying the mass by simple rules. Interobserver agreement was evaluated with Fleiss’ kappa and percentage agreement between observers. Results 50 consecutive women were included. We observed 46 discrepancies in the description of ovarian masses when non-experts utilized IOTA terminology. Tumor type was misclassified often (n = 22), resulting in poor interobserver agreement between the non-experts and the expert (kappa = 0.39, 95 %-CI 0.244 – 0.529, percentage of agreement = 52.0 %). Misinterpretation of simple rules by non-experts was observed 57 times, resulting in an erroneous diagnosis in 15 patients (30 %). The agreement for classifying the mass as benign, malignant or inconclusive by simple rules was only moderate between the non-experts and the expert (kappa = 0.50, 95 %-CI 0.300 – 0.704, percentage of agreement = 70.0 %). The level of agreement for all 10 simple rules features varied greatly (kappa index range: -0.08 – 0.74, percentage of agreement 66 – 94 %). Conclusion Although simple rules are useful to distinguish benign from malignant adnexal masses, they are not that simple for untrained examiners. Training with both IOTA terminology and simple rules is necessary before simple rules can be introduced into guidelines and daily clinical practice.

scholarly journals Reproducibility of a new classification of the anterior clinoid process of the sphenoid bone

2020 ◽  
Vol 11 ◽  
pp. 281
Author(s):  
Feres Chaddad-Neto ◽  
Marcos Devanir Silva da Costa ◽  
Bruno Santos ◽  
Ricardo Lourenco Caramanti ◽  
Bruno Lourenco Costa ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Anatomical Variation ◽  
Ct Scans ◽  
Multiplanar Reconstruction ◽  
Kappa Index ◽  
Anterior Clinoid Process ◽  
Kappa Test ◽  
Optic Strut ◽  
The Difference

Background: Pneumatization of the anterior clinoid process (ACP) affects paraclinoid region surgery, this anatomical variation occurs in 6.6–27.7% of individuals, making its preoperative recognition essential given the need for correction based on the anatomy of the pneumatized process. This study was conducted to evaluate the reproducibility of an optic strut-based ACP pneumatization classification by presenting radiological examinations to a group of surgeons. Methods: Thirty cranial computer tomography (CT) scans performed from 2013 to 2014 were selected for analysis by neurosurgery residents and neurosurgeons. The evaluators received Google Forms with questionnaires on each scan, DICOM files to be manipulated in the Horos software for multiplanar reconstruction, and a collection of slides demonstrating the steps for classifying each type of ACP pneumatization. Interobserver agreement was calculated by the Fleiss kappa test. Results: Thirty CT scans were analyzed by 37 evaluators, of whom 20 were neurosurgery residents and 17 were neurosurgeons. The overall reproducibility of the ACP pneumatization classification showed a Fleiss kappa index of 0.49 (95% confidence interval: 0.49–0.50). The interobserver agreement indices for the residents and neurosurgeons were 0.52 (0.51–0.53) and 0.49 (0.48–0.50), respectively, and the difference was statistically significant (P < 0.00001). Conclusion: The optic strut-based classification of ACP pneumatization showed acceptable concordance. Minor differences were observed in the agreement between the residents and neurosurgeons. These differences could be explained by the residents’ presumably higher familiarity with multiplanar reconstruction software.

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