ABSTRACT
Background@#The International Endometrial Tumor Analysis (IETA) group developed a catalog of standardized terms to describe findings that may be associated with uterine pathology. However, there is a lack of reliability studies for these descriptors in the literature.@*Objective@#The objective of this study was to estimate interobserver and intraobserver reliability with regard to the IETA group descriptors for endometrial vascular characteristics in women with abnormal uterine bleeding.@*Materials and Methods@#Five nonexpert and five expert raters assessed stored still images of transvaginal ultrasound examinations obtained from 68 women with abnormal uterine bleeding and endometrial thickening. Endometrial vascularity was evaluated using the IETA group descriptors for color flow and vascular pattern. Interobserver agreement was estimated by comparing the assessments of the nonexpert and expert raters. Intraobserver agreement was estimated by repeating the raters’ assessment after 4 weeks. Interrater agreement to the subjective assessment of an expert investigator was also computed.@*Results and Conclusion@#The reproducibility of assigning IETA color score is good regardless of the degree of expertise of the rater, although the experts displayed better interobserver reliability (κ = 0.74 vs. 0.57) and intraobserver reliability (κ = 0.84 vs. 0.63). However, the reproducibility of describing IETA vascular patterns is significantly worse for both expert and nonexpert raters in both interobserver reliability (experts κ = 0.49 vs. 0.34) and intraobserver reliability (experts κ = 0.65 vs. 0.42). Both expert and nonexpert raters exhibited acceptable agreement with the reference standard, with experts performing better for both color score (κ = 0.79 vs. 0.70) and vascular pattern (κ = 0.63 vs. 0.44).
Subject(s)
EndometriumABSTRACT
@#Cesarean section scar pregnancy (CSP) is a pregnancy implanted outside the uterine cavity in the site of a previous cesarean section scar and is considered the rarest form ectopic pregnancy. CSP is a modern phenomenon and has been reported with increasing incidence due to either an increased reporting or increasing cesarean section rate. The true incidence, however, has not been fully determined as some cases will end up in the first trimester and go unreported or undiagnosed. Undiagnosed cesarean scar pregnancy can be fatal due to life threatening hemorrhage as well as uterine rupture due to an abnormally adherent placenta. Accurate diagnosis is important because it enables the clinicians to establish the risk of complications and aid in prompt management. Ultrasonography is often the first step in detecting CSP and MRI should only be used in equivocal cases. The case presented is in a multiparous woman with ultrasound finding of a cesarean scar pregnancy where expectant management was the initial option but because of the outward progression of the CSP, it was terminated. There is no established universal treatment guidelines for CSP and treatment options include expectant, medical, surgical or combinations of these.