Luis Alonso Pacheco1, Carmina Bermejo López2, José Carugno3, Pedro Azumendi Gómez1, Pilar Martinez-Ten2, Antonio Simone Laganà4, Simone Garzon5. 1. Reproductive Surgery Unit, Centro Gutenberg, Malaga, Spain. 2. Delta Ecografía, Madrid, Spain. 3. Miller School of Medicine, Obstetrics and Gynecology Department, University of Miami, Miami, FL, USA. 4. Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy. antoniosimone.lagana@uninsubria.it. 5. Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.
Abstract
PURPOSE: To investigate and propose a new simple tridimensional (3D) ultrasonographic method to diagnose a T-shaped uterus (Class U1a). METHODS: A multicenter non-experimental case-control diagnostic accuracy study was conducted between January 2018 and December 2019, including 50 women (cases) diagnosed with T-shaped uterus (U1a class) and 50 women with a "normal uterus" (controls). All the enrolled women underwent 3D ultrasound, drawing four lines and recording the length of three of them as follow: draw and measure the interostial line (R0); draw from the midpoint of R0 a perpendicular line length 20 mm; draw and measure in the uterine cavity a line parallel to R0 at 10 mm below R0 (R10) and a second line parallel to R0 at 20 mm below R0 (R20). The diagnostic performance of all sonographic parameters statistically significantly different between T-shaped and normal uteri was estimated using the receiver operator characteristic (ROC) curve analysis. RESULTS: R10 and R20 were statistically significantly shorter in the T-shaped than the normal uterus. R10 reported the highest diagnostic accuracy with an area under the ROC curve of 0.973 (95% CI 0.940-1.000). R10 length maximizing the Youden's J statistic was 10.5 mm. Assuming R10 length equal to or shorter than 10 mm as the cut off value for defining a woman as having a T-shaped uterus, the new ultrasonographic method following the proposed protocol (R0, R10, and R20) reported sensitivity for T-shaped uterus of 91.1% (95% CI 0.78-0.97%) and a specificity of 100% (95% CI 0.89-100%). The positive likelihood ratio was higher than 30, and the negative likelihood ratio was 0.09 (95% CI 0.04-0.26). CONCLUSIONS: Measuring the length of the intracavitary line parallel to the interostial line at 10 mm from it and using a length ≤ of 10 mm as cut off value (the "Rule of 10") appears a simple and accurate 3D ultrasonographic method for the diagnosis of a T-shaped uterus.
PURPOSE: To investigate and propose a new simple tridimensional (3D) ultrasonographic method to diagnose a T-shaped uterus (Class U1a). METHODS: A multicenter non-experimental case-control diagnostic accuracy study was conducted between January 2018 and December 2019, including 50 women (cases) diagnosed with T-shaped uterus (U1a class) and 50 women with a "normal uterus" (controls). All the enrolled women underwent 3D ultrasound, drawing four lines and recording the length of three of them as follow: draw and measure the interostial line (R0); draw from the midpoint of R0 a perpendicular line length 20 mm; draw and measure in the uterine cavity a line parallel to R0 at 10 mm below R0 (R10) and a second line parallel to R0 at 20 mm below R0 (R20). The diagnostic performance of all sonographic parameters statistically significantly different between T-shaped and normal uteri was estimated using the receiver operator characteristic (ROC) curve analysis. RESULTS: R10 and R20 were statistically significantly shorter in the T-shaped than the normal uterus. R10 reported the highest diagnostic accuracy with an area under the ROC curve of 0.973 (95% CI 0.940-1.000). R10 length maximizing the Youden's J statistic was 10.5 mm. Assuming R10 length equal to or shorter than 10 mm as the cut off value for defining a woman as having a T-shaped uterus, the new ultrasonographic method following the proposed protocol (R0, R10, and R20) reported sensitivity for T-shaped uterus of 91.1% (95% CI 0.78-0.97%) and a specificity of 100% (95% CI 0.89-100%). The positive likelihood ratio was higher than 30, and the negative likelihood ratio was 0.09 (95% CI 0.04-0.26). CONCLUSIONS: Measuring the length of the intracavitary line parallel to the interostial line at 10 mm from it and using a length ≤ of 10 mm as cut off value (the "Rule of 10") appears a simple and accurate 3D ultrasonographic method for the diagnosis of a T-shaped uterus.
Authors: Luis Alonso Pacheco; Antonio Simone Laganà; Fabio Ghezzi; Sergio Haimovich; Pedro Azumendi Gómez; Jose Carugno Journal: Fertil Steril Date: 2019-05-24 Impact factor: 7.329
Authors: Grigoris F Grimbizis; Attilio Di Spiezio Sardo; Sotirios H Saravelos; Stephan Gordts; Caterina Exacoustos; Dominique Van Schoubroeck; Carmina Bermejo; Nazar N Amso; Geeta Nargund; Dirk Timmermann; Apostolos Athanasiadis; Sara Brucker; Carlo De Angelis; Marco Gergolet; Tin Chiu Li; Vasilios Tanos; Basil Tarlatzis; Roy Farquharson; Luca Gianaroli; Rudi Campo Journal: Gynecol Surg Date: 2015-11-04