{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:33:26Z","timestamp":1791862406163,"version":"4.3.4"},"reference-count":39,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T00:00:00Z","timestamp":1589500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009045","name":"Uniwersytet Jagiello\u0144ski Collegium Medicum","doi-asserted-by":"publisher","award":["grant no. K\/ZDS\/005568"],"award-info":[{"award-number":["grant no. K\/ZDS\/005568"]}],"id":[{"id":"10.13039\/100009045","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To identify uterine measurements that are reliable and accurate to distinguish between T\u2010shaped and normal\/arcuate uterus, and define T\u2010shaped uterus, using Congenital Uterine Malformation by Experts (CUME) methodology, which uses as reference standard the decision made most often by several independent experts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a prospectively planned multirater reliability\/agreement and diagnostic accuracy study, performed between November 2017 and December 2018, using a sample of 100 three\u2010dimensional (3D) datasets of different uteri with lateral uterine cavity indentations, acquired from consecutive women between 2014 and 2016. Fifteen representative experts (five clinicians, five surgeons and five sonologists), blinded to each others' opinions, examined anonymized images of the coronal plane of each uterus and provided their independent opinion as to whether it was T\u2010shaped or normal\/arcuate; this formed the basis of the CUME reference standard, with the decision made most often (i.e. that chosen by eight or more of the 15 experts) for each uterus being considered the correct diagnosis for that uterus. Two other experienced observers, also blinded to the opinions of the other experts, then performed independently 15 sonographic measurements, using the original 3D datasets of each uterus. Agreement between the diagnoses made by the 15 experts was assessed using kappa and percent agreement. The interobserver reliability of measurements was assessed using the concordance correlation coefficient (CCC). The diagnostic test accuracy was assessed using the area under the receiver\u2010operating\u2010characteristics curve (AUC) and the best cut\u2010off value was assessed by calculating Youden's index, according to the CUME reference standard. Sensitivity, specificity, negative and positive likelihood ratios (LR\u2013 and LR+) and post\u2010test probability were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      According to the CUME reference standard, there were 20 T\u2010shaped and 80 normal\/arcuate uteri. Individual experts recognized between 5 and 35 (median, 19) T\u2010shaped uteri on subjective judgment. The agreement among experts was 82% (kappa\u2009=\u20090.43). Three of the 15 sonographic measurements were identified as having good diagnostic test accuracy, according to the CUME reference standard: lateral indentation angle (AUC\u2009=\u20090.95), lateral internal indentation depth (AUC\u2009=\u20090.92) and T\u2010angle (AUC\u2009=\u20090.87). Of these, T\u2010angle had the best interobserver reproducibility (CCC\u2009=\u20090.87\u2009\n                      <jats:italic>vs<\/jats:italic>\n                      \u20090.82\u2009\n                      <jats:italic>vs<\/jats:italic>\n                      \u20090.62 for T\u2010angle\n                      <jats:italic>vs<\/jats:italic>\n                      lateral indentation depth\n                      <jats:italic>vs<\/jats:italic>\n                      lateral indentation angle). The best cut\u2010off values for these measurements were: lateral indentation angle \u2264\u2009130\u00b0 (sensitivity, 80%; specificity, 96%; LR+, 21.3; LR\u2013, 0.21), lateral indentation depth \u2265\u20097\u2009mm (sensitivity, 95%; specificity, 77.5%; LR+, 4.2; LR\u2013, 0.06) and T\u2010angle \u2264\u200940\u00b0 (sensitivity, 80%; specificity, 87.5%; LR+, 6.4; LR\u2013, 0.23). Most of the experts diagnosed the uterus as being T\u2010shaped in 0% (0\/56) of cases when none of these three criteria was met, in 10% (2\/20) of cases when only one criterion was met, in 50% (5\/10) of cases when two of the three criteria were met, and in 93% (13\/14) of cases when all three criteria were met.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The diagnosis of T\u2010shaped uterus is not easy; the agreement among experts was only moderate and the judgement of individual experts was commonly insufficient for accurate diagnosis. The three sonographic measurements with cut\u2010offs that we identified (lateral internal indentation depth \u2265\u20097\u2009mm, lateral indentation angle \u2264\u2009130\u00b0 and T\u2010angle \u2264\u200940\u00b0) had good diagnostic test accuracy and fair\u2010to\u2010moderate reliability and, when applied in combination, they provided high post\u2010test probability for T\u2010shaped uterus. In the absence of other anomalies, we suggest considering a uterus to be normal when none or only one criterion is met, borderline when two criteria are met, and T\u2010shaped when all three criteria are met. These three CUME criteria for defining T\u2010shaped uterus may aid in determination of its prevalence, clinical implications and best management and in the assessment of post\u2010surgical morphologic outcome. The CUME definition of T\u2010shaped uterus may help in the development of interventional randomized controlled trials and observational studies and in the diagnosis of uterine morphology in everyday practice, and could be adopted by guidelines on uterine anomalies to enrich their classification systems. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.20845","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T00:53:36Z","timestamp":1566348816000},"page":"815-829","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Congenital Uterine Malformation by Experts (\n                    <scp>CUME<\/scp>\n                    ): diagnostic criteria for T\u2010shaped uterus"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5853-8661","authenticated-orcid":false,"given":"A.","family":"Ludwin","sequence":"first","affiliation":[{"name":"Department of Gynecology and Oncology Jagiellonian University  Krakow Poland"},{"name":"Ludwin &amp; Ludwin Gynecology Private Medical Center  Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. A.","family":"Coelho Neto","sequence":"additional","affiliation":[{"name":"SEMEAR Fertilidade Reproductive Medicine, Ribeir\u00e3o Preto  Brazil"},{"name":"Department of Obstetrics and Gynaecology, Faculty of Medicine of Ribeir\u00e3o Preto University of S\u00e3o Paulo (DGO\u2010FRMP\u2010USP), Ribeir\u00e3o Preto  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Ludwin","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Oncology Jagiellonian University  Krakow Poland"},{"name":"Ludwin &amp; Ludwin Gynecology Private Medical Center  Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. O.","family":"Nastri","sequence":"additional","affiliation":[{"name":"SEMEAR Fertilidade Reproductive Medicine, Ribeir\u00e3o Preto  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Costa","sequence":"additional","affiliation":[{"name":"SEMEAR Fertilidade Reproductive Medicine, Ribeir\u00e3o Preto  Brazil"},{"name":"Department of Obstetrics and Gynaecology, Faculty of Medicine of Ribeir\u00e3o Preto University of S\u00e3o Paulo (DGO\u2010FRMP\u2010USP), Ribeir\u00e3o Preto  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Aci\u00e9n","sequence":"additional","affiliation":[{"name":"San Juan University Hospital\/Miguel Hern\u00e1ndez University  Alicante Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9700-0853","authenticated-orcid":false,"given":"J. L.","family":"Alcazar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Navarra  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0177-7626","authenticated-orcid":false,"given":"B.","family":"Benacerraf","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Condous","sequence":"additional","affiliation":[{"name":"Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean University of Sydney  Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"DeCherney","sequence":"additional","affiliation":[{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development  Bethesda MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.\u2010L.","family":"De Wilde","sequence":"additional","affiliation":[{"name":"Carl von Ossietzky University Oldenburg  Oldenburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. P.","family":"Diamond","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Augusta University  Augusta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. H.","family":"Emanuel","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Reproductive Medicine University Medical Center Utrecht  Utrecht The Netherlands"},{"name":"Department of Gynaecology University Hospital Ghent  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1359-7155","authenticated-orcid":false,"given":"S.","family":"Guerriero","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Cagliari  Cagliari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Hurd","sequence":"additional","affiliation":[{"name":"Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology Duke University Medical Center  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of Radiology Beth Israel Deaconess Medical Center  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Lindheim","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Wright State University, Boonshoft School of Medicine  Dayton OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Pellicer","sequence":"additional","affiliation":[{"name":"Instituto Valenciano de Infertilidad  Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Petraglia","sequence":"additional","affiliation":[{"name":"University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Saridogan","sequence":"additional","affiliation":[{"name":"University College London Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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