Accuracy of three‐dimensional ultrasound compared with magnetic resonance imaging in diagnosis of Müllerian duct anomalies using ESHRE–ESGE consensus on the classification of congenital anomalies of the female genital tract

Abstract

Objective To establish the accuracy of three-dimensional ultrasound (3D-US), compared with magnetic resonance imaging (MRI), for diagnosing uterine anomalies, using the European Society of Human Reproduction and Embryology-European Society for Gynaecological Endoscopy (ESHRE-ESGE) consensus on the classification of congenital anomalies of the female genital tract. Methods

Diagnostic rate and accuracy of the ESHRE–ESGE classification for septate uterus and other common uterine malformations: why do we not see that the Emperor is naked?

“…If this confusing subclass is not excluded, there is an unacceptable relative risk (RR, 4.5; 95% CI, 3.4-6; P < 0.01) of overdiagnosis of all the anomalies 3 . Thus, in this study 1 , an important part of the population (patients without suspicion of uterine malformations according to ASRM, i.e. who have normal or U1c dysmorphic uterus, some with partially septate uteri according to ESHRE-ESGE) is omitted 2 .…”

“…who have normal or U1c dysmorphic uterus, some with partially septate uteri according to ESHRE-ESGE) is omitted 2 . In the total group that Graupera et al 1 excluded from secondary analysis (i.e. patients without ultrasound suspicion of malformations and patients who underwent only hysteroscopy as the reference standard), the ESHRE-ESGE classification may be most unsatisfactory with regards to detecting the degree of distortion of the internal and external structure of the uterus 3 , reliability (κ < 0.9) 5 and, ultimately, diagnostic accuracy.…”

Reply

“…We thank Drs Ludwin and Ludwin for their interest in our article 1 . First and foremost, we would like to point out that our study is not a validation of the new European Society of Human Reproduction and Embryology-European Society for Gynaecological Endoscopy (ESHRE-ESGE) 2 over the American Society for Reproductive Medicine (ASRM) 3 classification system.…”

“…In 92 cases hysteroscopy only was performed, in 16 cases MRI only was performed and 44 patients underwent both hysteroscopy and MRI 4 . In the present retrospective study, only comparison with MRI results (60 cases) was performed because MRI results can be analyzed retrospectively using the new classification; hysteroscopy results do not allow retrospective analysis of uterine morphology 1 .…”

“…We consider the methodology used and our objective in both studies to be clear: the accuracy of 3D-US in the same cohort compared with MRI and/or hysteroscopy in the original study 4 using the ASRM classification and the accuracy of 3D-US compared with MRI using the ESHRE-ESGE classification in the second one 1 .…”