OC29.04: T‐shaped uterus by Congenital Uterine Malformation by Experts (CUME): agreement of subjective assessment among top expert

To assess the level of agreement among experts in the recognition of t-shaped uterus using subjective judgments from review of coronal view images from three-dimensional ultrasound. This was a prospectively designed multirater reliability/agreement study with elements of diagnostic accuracy study performed between Nov-2017 and Dec-2018 in a sample of 100 3D datasets of different uteri acquired in consecutive women with suspected uterine anomaly due to the presence of lateral uterine cavity indentations between 2014-2016. 15 blinded representative experts (5 clinicians, 5 surgeons and 5 imaging specialists) provided their independent opinion whether that the uterus was t-shaped or not regarding anonymised images of the coronal plane of each uterus. Agreement among experts was assessed by kappa index (Fleiss kappa for multiple raters) and by the observed proportion of agreement. There were 20 t-shaped and 80 normal/arcuate uteri using as reference standard the most voted option (8 or more votes) by the 15 experts. From the 1500 votes, there were 305 votes for t-shaped uterus (20%) with moderate level of agreement: kappa = 0.43 and observed agreement = 82%. There were differences in the agreement expressed by kappa among the groups of experts: sonologists and clinicians had moderate level of agreement (0.45 and 0.48, respectively), while surgeons achieved fair level (0.31). Observed agreement was highest among sonologists (86%) in comparison to surgeons (80%) and clinicians (79%). Clinicians more often diagnosed t-shaped uterus (28%) than surgeons (17%) and sonologists (16%). Diagnosis of t-shaped uterus is challenging. The level of agreement between top experts based on subjective assessment of coronal view of uterus from three-dimensional ultrasound is only moderate. Therefore, the subjective opinion of a single expert might not be considered sufficient reliable for the diagnosis and management of t-shaped uterus.