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?

Abstract

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?In our opinion, the results of the recent retrospective study of Graupera et al.

Congenital Uterine Malformation by Experts (CUME): better criteria for distinguishing between normal/arcuate and septate uterus?

“…Revised interpretation of these studies' results using newly proposed cut-offs confirms that the reliability of measurements of internal indentation depth is significantly better than those of the indentation angle and the uterine wall thickness 23 . Moreover, the paradox of using an index based on the uterine wall (a variable parameter that is independent of deformity) for assessment of uterine cavity shape has been highlighted previously 35 : a small internal indentation may be recognized as septate uterus, and larger internal indentation as normal uterus depending on the uterine wall thickness 18,34,36 . Suggested cut-offs for uterine wall thickness by the study results (septate when I:WT > 110%) showed that I:WT can be accurate in diagnosis, but a wide margin of error for this benchmark (approximately ± 80% just by another observer repeating the measurement) indicates problems of its use in clinical practice.…”

Reliability of the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy and American Society for Reproductive Medicine classification systems for congenital uterine anomalies detected using three-dimensional ultrasonography

“…5, available online) (45). This is an additional reason (beside the ESHRE-ESGE paradox: slight internal indentation may be recognized as a malformation, whereas a larger indentation may be recognized as a normal uterus depending on the uterine wall thickness) (46). The uterine wall thickness should not be a benchmark for the diagnosis of congenital uterine malformations (23,30,34).…”

Uterine cavity imaging, volume estimation and quantification of degree of deformity using automatic volume calculation: description of technique

“…However, the reliability and validity of this method need to be assessed in prospective studies. Whether the resulting images and volume measurements contribute to better understanding of uterine morphology and the relationship between uterine cavity volume, normal and abnormal uterine cavity shape and reproductive failure should be evaluated. Finally, refinement and testing of the newly proposed morphological indices for classification of uterine distortions (Figure ) should be performed.…”

“…The availability of non‐invasive imaging techniques that allow evaluation of the uterus in the coronal plane, such as three‐dimensional (3D) ultrasound and magnetic resonance imaging, should improve diagnosis of uterine anomalies. However, current definitions for uterine morphology are controversial, which is a key limitation of studies evaluating the effectiveness of interventions for women with such conditions.…”