The use of IETA terminology and other ultrasound features in the diagnosis of intracavitary fibroids and polyps

Objectives:The primary aim is to evaluate interobserver agreementon International Endometrial Tumour Analysis (IETA) terminologyand other ultrasound (US) features (‘‘bridge sign’’, lesion shape and”fan-shaped shadowing”) of polyps and fibroids. The secondary aimis to assess the relevance of these US features in the diagnosis ofpolyps and fibroids.Methods:From Leuven University Hospital Bleeding Clinic weselected stored 3D-volumes of 113 non-consecutive patients witha final pathologic diagnosis of fibroid or polyp. 3D-volumes ofunenhanced transvaginal US examinations on grayscale (GS) andwith Doppler signal (DS) as well as fluid instillation sonography(FIS) in GS and adding DS (FIS&DS) were converted in videoclips. Two experienced sonographers, blinded to pathology results,scored the clips for the presence of the US features and proposeda diagnosis. Interobserver agreement was determined using Cohen’skappa coefficient (k).Results:There were 71 polyps and 42 fibroids. Interobserveragreement was good for ‘‘circular flow’’, both on DS (k=0.66)andonFIS&DS(k=0.62), moderate for the ‘‘bridge sign’’ on GS(k=0.50), lesion shape on FIS (k=0.44), ‘‘single dominant vessel’’on FIS&DS (k=0.57), ‘‘fan-shaped shadowing’’ on FIS (k=0.57)and for ‘‘multiple vessels with focal origin’’ on FIS&DS (k=0.60).In polyps, sonographers reported an oval shape on FIS in 76-77%(percentage for sonographer 1 and 2), a ‘‘single dominant vessel’’on FIS&DS in 32-37% and ‘‘multiple vessels with focal origin’’on FIS&DS in 15-20%. In fibroids, the sonographers reported the‘‘bridge sign’’ on GS in 36-45%, ‘‘fan-shaped shadowing’’ on FISin 38-52% and ‘‘circular flow’’ on DS in 29-52% and on FIS&DSin 38-57%. Examiners agreed on the diagnosis in 82% of the cases(k=0.69); 63% were polyps.Conclusions:Interobserver agreement for some of the US features isgood to moderate. These may be selected in the differential diagnosisbetween polyps and intracavitary fibroids. Overall there was a goodagreement on the diagnosis between both examiners.