Department of Obstetrics and Gynecology, Centro Hospitalar São João, Porto, Portugal.
Faculty of Medicine, University of Porto, Porto, Portugal.
Rev Bras Ginecol Obstet. 2021 Dec;43(12):911-918. doi: 10.1055/s-0041-1740271. Epub 2021 Dec 21.
Currently, there are up to three different classifications for diagnosing septate uterus. The interobserver agreement among them has been poorly assessed.
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.
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.
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.
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.
目前，有多达三种不同的分类方法用于诊断纵隔子宫。它们之间的观察者间一致性评估较差。
评估非专家超声医师使用欧洲人类生殖与胚胎学会/欧洲妇科内镜学会（ESHRE/ESGE）、美国生殖医学学会（ASRM）和专家先天性子宫畸形分类（CUME）对纵隔子宫进行分类的观察者间一致性。
使用非连续系列疑似子宫畸形妇女的 50 个三维（3D）容积。两名非专家检查者在彼此不知情的情况下对每位妇女的单个 3D 子宫容积进行评估。进行以下测量：凹陷深度、凹陷角度、子宫底壁厚度、外部底凹陷和凹陷与壁厚度比（I：WT）。每个观察者都必须根据三个分类系统（ESHRE/ESGE、ASRM 和 CUME）对每种情况进行诊断。使用 Cohen 加权kappa 指数（k）评估 ESHRE/ESGE、ASRM 和 CUME 分类之间的观察者间一致性。还评估了三种分类（ASRM 与 ESHRE/ESGE、ASRM 与 CUME、ESHRE/ESGE 与 CUME）之间的一致性。
两名非专家检查者之间的 ESHRE/ESGE 观察者间一致性良好（k=0.74；95%置信区间[CI]：0.55-0.92），ASRM 和 CUME 分类系统的观察者间一致性非常好（k=0.95；95%CI：0.86-1.00；k=0.91；95%CI：0.79-1.00）。两位检查者的 ESHRE/ESGE 和 ASRM 分类之间的一致性为中度。检查者 1 的 ESHRE/ESGE 和 CUME 分类之间的一致性为中度，检查者 2 的一致性为良好。ASRM 和 CUME 分类之间的一致性对于两位检查者均为良好。
这三种分类方法具有良好的（ESHRE/ESGE）或非常好的（ASRM 和 CUME）观察者间一致性。ASRM 和 CUME 分类之间的一致性高于 ESHRE/ESGE 和 ASRM 以及 ESHRE/ESGE 和 CUME 分类之间的一致性。
