Three-dimensional ultrasound in the diagnosis and the classification of congenital uterine anomalies using the ESHRE/ESGE classification: a diagnostic accuracy study

  • Anna KougioumtsidouEmail author
  • Themistoklis Mikos
  • Grigoris F. Grimbizis
  • Aikaterini Karavida
  • Theodoros D. Theodoridis
  • Alexandros Sotiriadis
  • Basil C. Tarlatzis
  • Apostolos P. Athanasiadis
General Gynecology


Study objective

To estimate the diagnostic accuracy of three-dimensional ultrasonography (3D US) compared to hysteroscopy/laparoscopy, in the investigation of uterine congenital anomalies using the ESHRE/ESGE classification of female genital tract congenital anomalies.


Prospective blind, comparative, cohort study.


University Tertiary Hospital and affiliated private Hospital.

Patients and methods

Sixty-two women consecutively referred with a suspected diagnosis of uterine congenital anomalies. The ESHRE/ESGE classification of congenital anomalies of the female genital tract was used for the description of abnormal findings.


All patients underwent (1) 3D US and (2) hysteroscopy with laparoscopy to establish the final diagnosis.


Concordance between 3D US and hysteroscopy with laparoscopy about the type and the classification of uterine anomaly was verified in 61 cases, including all those with septate uterus, dysmorphic uterus, bicorporeal, hemi-uterus or unicorporeal, and aplastic uterus and one out of two with normal uterus. For the diagnosis of septate uteri, which was the most common anomaly, the sensitivity of 3D US was 100%, the specificity was 92.3%, the PPV was 98% and the NPV was 100%, with kappa index 0.950. For bicorporeal, dysmorphic uterus, hemi-uteri or unicorporeal and aplastic uterus the sensitivity, specificity, PPV and NPV were all 100% with K = 1.00. Overall, 3D US showed perfect diagnostic accuracy (Kappa index = 0.945) in the detection of congenital uterine anomalies.


3D US appears to be a very accurate method for the diagnosis of congenital uterine anomalies.


Three-dimensional ultrasound Congenital anomalies of the female genital tract Hysteroscopy Laparoscopy ESHRE/ESGE classification system 


Authors’ contribution

AK: Data collection, Manuscript writing, data analysis. TM: Manuscript writing—review and editing, protocol development. GFG: Protocol development, data collection, conceptualization, investigation, project administration, supervision. AK: Data collection, investigation. TDT: Data collection, investigation. AS: Protocol development, supervision. BCT: Supervision. APA: Protocol development, data collection, conceptualization, investigation, project administration, supervision, validation.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

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Supplementary material 1 (DOCX 138 kb)
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Supplementary material 2 (DOCX 91 kb)
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Supplementary material 3 (DOCX 132 kb)
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Supplementary material 4 (DOCX 175 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Anna Kougioumtsidou
    • 1
    Email author
  • Themistoklis Mikos
    • 1
  • Grigoris F. Grimbizis
    • 1
  • Aikaterini Karavida
    • 1
  • Theodoros D. Theodoridis
    • 1
  • Alexandros Sotiriadis
    • 1
  • Basil C. Tarlatzis
    • 1
  • Apostolos P. Athanasiadis
    • 1
  1. 1.1st Department of Obstetrics and GynecologyPapageorgiou General HospitalThessalonikiGreece

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