title: Detection of intracavitary uterine pathology using offline analysis of three-dimensional ultrasound volumes: interobserver agreement and diagnostic accuracy.
abstract: OBJECTIVE
  To estimate the diagnostic accuracy and interobserver agreement in predicting intracavitary uterine pathology at offline analysis of three-dimensional (3D) ultrasound volumes of the uterus.
  
  
  METHODS
  3D volumes (unenhanced ultrasound and gel infusion sonography with and without power Doppler, i.e. four volumes per patient) of 75 women presenting with abnormal uterine bleeding at a 'bleeding clinic' were assessed offline by six examiners. The sonologists were asked to provide a tentative diagnosis. A histological diagnosis was obtained by hysteroscopy with biopsy or operative hysteroscopy. Proliferative, secretory or atrophic endometrium was classified as 'normal' histology; endometrial polyps, intracavitary myomas, endometrial hyperplasia and endometrial cancer were classified as 'abnormal' histology. The diagnostic accuracy of the six sonologists with regard to normal/abnormal histology and interobserver agreement were estimated.
  
  
  RESULTS
  Intracavitary pathology was diagnosed at histology in 39% of patients. Agreement between the ultrasound diagnosis and the histological diagnosis (normal vs abnormal) ranged from 67 to 83% for the six sonologists. In 45% of cases all six examiners agreed with regard to the presence/absence of intracavitary pathology. The percentage agreement between any two examiners ranged from 65 to 91% (Cohen's κ, 0.31-0.81). The Schouten κ for all six examiners was 0.51 (95% CI, 0.40-0.62), while the highest Schouten κ for any three examiners was 0.69.
  
  
  CONCLUSIONS
  When analyzing stored 3D ultrasound volumes, agreement between sonologists with regard to classifying the endometrium/uterine cavity as normal or abnormal as well as the diagnostic accuracy varied substantially. Possible actions to improve interobserver agreement and diagnostic accuracy include optimization of image quality and the use of a consistent technique for analyzing the 3D volumes.
authors.affiliation: Department of Obstetrics & Gynecology, University Hospitals K.U. Leuven, Leuven, Belgium. thierry.van.den.bosch@skynet.be
authors.forename: T
authors.initials: T
authors.lastname: Van den Bosch
authors.forename: L
authors.initials: L
authors.lastname: Valentin
authors.forename: D
authors.initials: D
authors.lastname: Van Schoubroeck
authors.forename: J
authors.initials: J
authors.lastname: Luts
authors.forename: T
authors.initials: T
authors.lastname: Bignardi
authors.forename: G
authors.initials: G
authors.lastname: Condous
authors.forename: E
authors.initials: E
authors.lastname: Epstein
authors.forename: F P
authors.initials: FP
authors.lastname: Leone
authors.forename: A C
authors.initials: AC
authors.lastname: Testa
authors.forename: S
authors.initials: S
authors.lastname: Van Huffel
authors.forename: T
authors.initials: T
authors.lastname: Bourne
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D004715:Endometriosis / Q000000981:diagnostic imaging / Q000473:pathology*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D021621:Imaging, Three-Dimensional; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D015588:Observer Variation; D017698:Postmenopause; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D014599:Uterus / Q000000981:diagnostic imaging / Q000473:pathology*