title: The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies.
abstract: What is the recommended diagnostic work-up of female genital anomalies according to the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) system? The ESHRE/ESGE consensus for the diagnosis of female genital anomalies is presented. Accurate diagnosis of congenital anomalies still remains a clinical challenge due to the drawbacks of the previous classification systems and the non-systematic use of diagnostic methods with varying accuracy, with some of them quite inaccurate. Currently, a wide range of non-invasive diagnostic procedures are available, enriching the opportunity to accurately detect the anatomical status of the female genital tract, as well as a new objective and comprehensive classification system with well-described classes and sub-classes. The ESHRE/ESGE Congenital Uterine Anomalies (CONUTA) Working Group established an initiative with the goal of developing a consensus for the diagnosis of female genital anomalies. The CONUTA working group and imaging experts in the field have been appointed to run the project. The consensus is developed based on (1)evaluation of the currently available diagnostic methodsand, more specifically, oftheir characteristicswith the use of the experts panel consensus method and oftheir diagnostic accuracyperforming a systematic review of evidence and (2) consensus for (a) the definition of where and how to measure uterine wall thickness and (b) the recommendations for the diagnostic work-up of female genital anomalies, based on the results of the previous evaluation procedure, with the use of the experts panel consensus method. Uterine wall thickness is defined as the distance between interostial line and external uterine profile at the midcoronal plane of the uterus; alternatively, if a coronal plane is not available, the mean anterior and posterior uterine wall thickness at the longitudinal plane could be used. Gynaecological examination and two-dimensional ultrasound (2D US) are recommended for the evaluation of asymptomatic women. Three-dimensional ultrasound (3D US) is recommended for the diagnosis of female genital anomalies in "symptomatic" patients belonging to high-risk groups for the presence of a female genital anomaly and in any asymptomatic woman suspected to have an anomaly from routine avaluation. Magnetic resonance imaging (MRI) and endoscopic evaluation are recommended for the sub-group of patients with suspected complex anomalies or in diagnostic dilemmas. Adolescents with symptoms suggestive for the presence of a female genital anomaly should be thoroughly evaluated with 2D US, 3D US, MRI and endoscopy. The various diagnostic methods should be used in a proper way and evaluated by experts to avoid mis-, over- and underdiagnosis. The role of a combined ultrasound examination and outpatient hysteroscopy should be prospectively evaluated. It is a challenge for further research, based on diagnosis, to objectively evaluate the clinical consequences related to various degrees of uterine deformity.
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium ; 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Tsimiski 51 Street, 54623 Thessaloniki, Greece.
authors.forename: Grigoris F
authors.initials: GF
authors.lastname: Grimbizis
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Spiezio Sardo
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Sotirios H
authors.initials: SH
authors.lastname: Saravelos
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Stephan
authors.initials: S
authors.lastname: Gordts
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Caterina
authors.initials: C
authors.lastname: Exacoustos
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Van Schoubroeck
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Carmina
authors.initials: C
authors.lastname: Bermejo
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Nazar N
authors.initials: NN
authors.lastname: Amso
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Geeta
authors.initials: G
authors.lastname: Nargund
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Timmermann
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Athanasiadis
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Sara
authors.initials: S
authors.lastname: Brucker
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Carlo
authors.initials: C
authors.lastname: De Angelis
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Marco
authors.initials: M
authors.lastname: Gergolet
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Tin Chiu
authors.initials: TC
authors.lastname: Li
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Tanos
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Basil
authors.initials: B
authors.lastname: Tarlatzis
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Roy
authors.initials: R
authors.lastname: Farquharson
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Luca
authors.initials: L
authors.lastname: Gianaroli
authors.affiliation: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group and Invited Experts, Leuven, Belgium.
authors.forename: Rudi
authors.initials: R
authors.lastname: Campo
keywords: Classification; Diagnosis; ESHRE/ESGE system; Female genital anomalies; Genital tract; Mullerian anomalies; Uterine anomalies