OC13. 02: Reproducibility of IETA terms in describing endometrial pathology

Objectives To test the reproducibility of IETA (International Endometrial Tumor Analysis) terms in describing sonographic features in patients with endometrial hyperplasia. Methods Patients with histological diagnosis of endometrial hyperplasia (simple or complex, with or without atipiae) underwent transvaginal (TVUS) ultrasound and sonohysterography (SYS) performed by an expert examiner that stored images, clips and volumes. Some endometrial features were described applying IETA terms (echogenicity, endometrial midline, endo-myometrial junction, symmetry of layers at SYS, outline of endometrial background at SYS). A second expert ultrasound examiner reviewed clips and images using IETA terms, blinded to the description of the first examiner. Inter-observer variability was analysed. Results 50 patients were enrolled and underwent TVUS; 41 SYS were performed. At TVUS the agreement in the description of endometrial echogenicity was poor (32%, weighted kappa 0.163). The agreement in the description of endometrial midline was moderate (70%, weighted kappa 0.42). The agreement in the description of endo-myometrial junction was poor (66%, weighted kappa 0.035). At SYS, the agreement in the assessment of symmetry of endometrial layers was poor (59%, kappa 0.177) and the agreement in the description of the outline of endometrial background was moderate (59%, weighted kappa 0.435). Conclusions Despite the great effort in standardising terminology to describe endometrial appearance at ultrasound, in our series the assessment of endometrial features remains heterogeneous, partially subjective and not well reproducible.