International Endometrial Tumor Analysis (IETA) terminology in women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm: agreement and reliability study

Sladkevicius, Povilas; Installé, A.; Bosch, T. Van den; Timmerman, Dirk; Benacerraf, Beryl R.; Jokubkiene, L.; Legge, A. Di; Votino, A.; Zannoni, Letizia; Moor, Bart De; Cock, B. De; Calster, Ben Van; Valentin, Lil

doi:10.1002/uog.18813

Cited by 25 publications

(16 citation statements)

References 41 publications

(53 reference statements)

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“…Furthermore, the most relevant study on endometrial thickness measured transvaginal, which included 48,230 postmenopausal women [35], revealed that a cut-off of >5.15 mm is relevant for endometrial hyperplasia and cancer. Due to differences generated by practitioners in measuring and interpretation of ultra-sonographic results [36], a consensual, unique working protocol for ambulatory gynecological assessment is required. IETA (International Endometrial Tumor Analysis group) proposed an algorithm, which includes, besides endometrial thickness, the endometrial volume that might be of help in differentiating benign from malignant endometrial lesions [5,37].…”

Section: Discussionmentioning

confidence: 99%

The Correlation of the IETA Ultrasound Score with the Histopathology Results for Women with Abnormal Bleeding in Western Romania

et al. 2021

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In the early differential diagnosis of endometrial cancer (EC), decisive and mandatory histological aspects are considered, in addition to obvious clinical manifestations. In addition, sonographic aspects are characteristic in relation to the stage, degree, and histological types of identified cancer. This bi-center retrospective observational study included 594 women with abnormal uterine bleeding outside pregnancy, for which a biopsy was performed in the Obstetrics and Gynecology Departments of the Emergency County Hospitals of Arad and Timis Counties, Romania, between 2015 and 2019. Most of the cases were represented by EC or endometrial hyperplasia (EH). Of the 594 cases, 25.5% (n = 153) were EC at women aged between 41 and 85 years. High International Endometrial Tumor Analysis (IETA) scores (3, 4) were associated with a relative risk of 2.9335 compared with other endometrial lesions (95% CI 2.3046 to 3.734, P < 0.0001, NNT 1.805). Histological aspects and pelvic ultrasound using IETA scores represent valuable noninvasive assets in diagnosing and differentiating endometrial cancer from benign uterine pathology.

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Section: Discussionmentioning

confidence: 99%

The Correlation of the IETA Ultrasound Score with the Histopathology Results for Women with Abnormal Bleeding in Western Romania

et al. 2021

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“…Therefore, an additional attempt to identify women who may have endometrial hyperplasia, rather than a benign proliferative endometrium, on ultrasound would not have made a clinical difference to their initial management. Furthermore, by reducing the number of options available to the rater, we aimed to improve inter‐rater reliability, as proposed in a study by Sladkevicius et al 26 …”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the inter-rater reliability of subjective ultrasound pattern recognition and its diagnostic accuracy may be poorer when performed by less-experienced operators [23][24][25] . Furthermore, the intraand inter-rater reliabilities when using IETA terminology to describe ultrasound images of the endometrium were also found to be poor 26 . Notwithstanding these potential limitations, others have suggested that we should invest more in ultrasound training and consider limiting our use of different terminologies to those that are most reproducible 27 .…”

Section: Introductionmentioning

confidence: 99%

Ultrasound diagnosis of endometrial cancer by subjective pattern recognition in women with postmenopausal bleeding: prospective inter‐rater agreement and reliability study

Wong

Thanatsis

Amin

et al. 2021

Ultrasound in Obstet & Gyne

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Objectives To assess the inter‐rater agreement and reliability of using subjective pattern recognition for diagnosing endometrial cancer (EC) on ultrasound in women with postmenopausal bleeding (PMB). Methods This was a prospective cross‐sectional study conducted at a gynecological rapid‐access clinic, between October 2016 and December 2017, in which consecutive women with PMB and endometrial thickness of ≥ 4.5 mm on transvaginal ultrasound examination were included. Women on hormone replacement therapy or tamoxifen and those with a history of primary gynecological malignancy were excluded. Two raters independently performed ultrasound examinations, blinded to each other's findings, and classified women as having uniformly thickened endometrium, benign endometrial polyp or EC, using subjective pattern recognition. Inter‐rater reliability of ultrasound diagnosis was assessed using Cohen's kappa (κ) statistic. All women subsequently underwent either outpatient endometrial biopsy, hysteroscopy or hysterectomy. Results Forty women were included in the study, with a median age of 61 (interquartile range (IQR), 57–69) years and a median endometrial thickness of 11.0 (IQR, 6.2–20.3) mm. Final histological analysis confirmed 16 (40%) women with EC, 16 (40%) with benign endometrial polyp, four (10%) with atrophic endometrium, three (8%) with proliferative endometrium and one (3%) with endometrial hyperplasia. Inter‐rater agreement for the ultrasound diagnoses of uniformly thickened endometrium, benign endometrial polyp and EC was 14/16 (87.5%), 22/30 (73.3%) and 28/34 (82.4%), respectively; inter‐rater reliability was good (κ = 0.69; 95% CI, 0.49–0.88). When the ultrasound diagnoses were grouped as either cancer or no cancer, inter‐rater agreement was 85% and inter‐rater reliability was good (κ = 0.78; 95% CI, 0.61–0.95). Rater A correctly identified 14/16 cases of EC and Rater B identified 15/16. EC was misdiagnosed as benign polyps on ultrasound in two women by Rater A and in one woman by Rater B. The overall accuracies of Rater A and Rater B in differentiating between benign endometrial pathologies and malignancy were 90% and 90%, respectively. Conclusions Our results show good inter‐rater reliability of subjective pattern recognition in diagnosing uniformly thickened endometrium, benign endometrial polyp and EC on ultrasound in women with PMB. Our findings should facilitate wider use of subjective pattern recognition in routine clinical practice. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

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“…Sladkevicius and Valentin showed that the subjective assessment of benign and malignant tumors based on the work of the International Ovarian Tumor Analysis Group reached excellent reproducibility between 2 experienced raters. However, Leone et al concluded that there was limited agreement and reliability when using the terms of the International Endometrial Tumor Analysis Group and suggested that to improve the reproducibility, individual features should be combined, and training workshops should be available.…”

Section: Discussionmentioning

confidence: 99%

Intra‐ and Inter‐Rater Agreement Describing Myometrial Lesions Using Morphologic Uterus Sonographic Assessment: A Pilot Study

Rasmussen

Bosch

Exacoustòs

et al. 2019

J of Ultrasound Medicine

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Objectives-To evaluate the intra-and inter-rater agreement for myometrial lesions using Morphologic Uterus Sonographic Assessment terminology.Methods-Thirteen raters with high (n = 6) or medium experience (n = 7) assessed 30 3-dimensional ultrasound clips with (n = 20) and without (n = 10) benign myometrial lesions. Myometrial lesions were reported as poorly or well defined and then systematically evaluated for the presence of individual features. The clips were blindly assessed twice (at a 2-month interval). Intra-and interrater agreements were calculated with κ statistics.Results-The reporting of poorly defined lesions reached moderate intra-rater agreement (κ = 0.49 [high experience] and 0.47 [medium experience]) and poor inter-rater agreement (κ = 0.39 [high experience] and 0.25 [medium experience]). The reporting of well-defined lesions reached good to very good intra-rater agreement (κ = 0.73 [high experience] and 0.82 [medium experience]) and good inter-rater agreement (κ = 0.75 [high experience] and 0.63 [medium experience]). Most individual features associated with ill-defined lesions reached moderate intra-and inter-rater agreement among highly experienced raters (κ = 0.41-0.60). The least reproducible features were myometrial cysts, hyperechoic islands, subendometrial lines and buds, and translesional flow (κ = 0.11-0.34). Most individual features associated with well-defined lesions reached moderate to good intra-and inter-rater agreement among all observers (κ = 0.41-0.80). The least reproducible features were a serosal contour, asymmetry, a hyperechoic rim, and fan-shaped shadows (κ = 0.00-0.35).Conclusions-The reporting of well-defined lesions showed excellent agreement, whereas the agreement for poorly defined lesions was low, even among highly experienced raters. The agreement on identifying individual features varied, especially for features associated with ill-defined lesions. Guidelines on minimum requirements for features associated with ill-defined lesions to be interpreted as poorly defined lesions may improve agreement.

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International Endometrial Tumor Analysis (IETA) terminology in women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm: agreement and reliability study

Cited by 25 publications

References 41 publications

The Correlation of the IETA Ultrasound Score with the Histopathology Results for Women with Abnormal Bleeding in Western Romania

The Correlation of the IETA Ultrasound Score with the Histopathology Results for Women with Abnormal Bleeding in Western Romania

Ultrasound diagnosis of endometrial cancer by subjective pattern recognition in women with postmenopausal bleeding: prospective inter‐rater agreement and reliability study

Intra‐ and Inter‐Rater Agreement Describing Myometrial Lesions Using Morphologic Uterus Sonographic Assessment: A Pilot Study

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