OC17.04: Intra‐ and interobserver agreement using the MUSA terminology for ultrasonographic features associated with ill‐defined lesions

462 articles were discarded. Full text of 41 articles was reviewed, of which 33 were discarded and 8 articles that met all the inclusion criteria were finally selected for evaluation. A total of 4382 women were included. The prevalence of EC/HEA was 0.03% (72 cases). The relative risk of EC/EHA in the ≥11mm group was 3.1 (95% CI: 1.5–6.4). Moderate heterogeneity was observed between studies (I2: 44.6%, p = 0.08). Conclusions: The risk of EC/HEA in asymptomatic postmenopausal women with endometrial thickness ≥11mm is three times greater than in women with endometrial thickness <11mm. The indication of endometrial biopsy in these cases seems justifiable. OC17.04 Intraand interobserver agreement using the MUSA terminology for ultrasonographic features associated with ill-defined lesions C. Kjaergaard1, T. Van den Bosch6, C. Exacoustos13, G. Manegold-Brauer12, B.R. Benacerraf8, W. Froyman11, C. Landolfo14,15, M. Condorelli7, A.G. Egekvist9, H. Josefsson10, F. Leone2, L. Jokubkiene5, L. Zannoni4, E. Epstein10, A. Installé3, M. Dueholm1 1Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Obstetrics and Gynecology, DSC L Sacco, Milan, Italy; 3KU Leuven Department of Electrical Engineering (ESAT) – STADIUS, KU Leuven, Leuven, Belgium; 4Obstetrics and Gynecology, S Orsola Malpighi Hospital, Bologna, Italy; 5Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden; 6Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium; 7Erasmus University Hospital, Brussels, Belgium; 8Harvard Medical School, Brookline, MA, USA; 9Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; 10Department of Women’s and Children’s Health, Karolinska University Hospital, Stockholm, Sweden; 11University Hospital KULeuven, Leuven, Belgium; 12Department of Gynecologic Ultrasound and Prenatal Medicine, Women’s Hospital, University of Basel, Basel, Switzerland; 13Department of Biomedicine and Prevention, Obstetrics and Gynecology Clinic, Università degli Studi di Roma ‘‘Tor Vergata’’, Rome, Italy; 14Department of Development and Regeneration, KU Leuven, Leuven, Belgium; 15Department of Obstetrics and Gynecology, Leuven University Hospital, Leuven, Belgium Objectives: To evaluate intraand interobserver agreement in the reporting of ultrasonographic features associated with ill-defined lesions using the Morphological Uterus Sonographic Assessment (MUSA) terms. Methods: Multicentre clinical study, using three-dimensional (3D) transvaginal ultrasound clips of 30 premenopausal women suffering from abnormal uterine bleeding and/or menstrual pain. All women had transcervical deep resection of the endometrium and inner myometrium (n=25) or hysterectomy (n=5) and histopathological examination for adenomyosis (AM). Twelve women had a confident diagnosis of AM. Thirteen gynecologists with high (n=7) or medium (n=6) experience in TVS evaluated each 3D ultrasound clip in two rounds, with a two months’ interval, blinded to histopathology. The evaluation was managed online with Clinical Data Miner software and the presence of ill-defined lesions and associated features, as defined in MUSA, were recorded. Results are presented as interobserver agreement during the first evaluation and intraobserver agreement between first and second evaluation. © The Authors 2017 © Ultrasound in Obstetrics & Gynecology 2017; 50 (Suppl. 1): 1–47. 35 27th World Congress on Ultrasound in Obstetrics and Gynecology Oral communication abstracts Results: Intraobserver agreement (average kappa) for ill-defined lesions was moderate (0.45) and ranged from fair to moderate (0.29–0.45) for associated features. Interobserver agreement (kappa) for ill-defined lesions was poor (0.18) between all observers and fair (0.24) between highly experienced observers. Interobserver agreement for associated features ranged from poor to fair (0.08–0.32). Excluding medium experienced observers and patients without confident diagnosis of AM, interobserver agreement for associated features ranged from fair to moderate (0.20-0.40). Conclusions: There was large observer variation between multiple observers for ill-defined lesions and associated features. Presence of well-defined lesions, image orientation and the use of 3D video clips instead of 3D volumes may have influenced the findings. Future studies need to specify ill-defined lesions and the composition of associated features based on histopathology. OC17.05 New sonographic and hysteroscopic combined classification for surgical repair of isthmoceles in an outpatient setting to ensure maximum safety in minimal invasive surgery A.M. Dueckelmann1, J. Barinoff1, G. Gubbini2, J. Sehouli1, E. Boschetti Grützmacher1 1Gynecology, Charité, Berlin, Germany; 2Casa di Cura Madre Fortunata Toniolo, Bologna, Italy Objectives: Isthmocele is a reservoir-like pouch defect on the anterior wall of the uterine isthmus located at the site of a previous Caesarean delivery scar, commonly detected on transvaginal ultrasound as a wedge-shaped anechoic area. Isthmoceles may be related to postmenstrual spotting and dark red or brown discharge, pelvic pain, infertility or ectopic pregnancy in this area. The removal of the local inflamed tissue may be performed by laparoscopic, combined laparoscopic-vaginal, or vaginal surgery, and operative hysteroscopy, a minimally invasive approach to improve symptoms. The aim of this study was to establish a classification of isthmoceles necessary to safely treat isthmoceles hysteroscopically under local anesthetic in an outpatient setting. Methods: In a prospective pilot study conventional (2D) and 3D sonography was performed in 39 patients with already known, symptomatic isthmoceles. The thickness of the myometrium above the isthmocele as well as the volumes of the isthmoceles were assessed. The appropriate surgical procedure, the surgical instruments and method of anesthesia were determined according to our established classification grade 1–3. Then the complete removal of the scar tissue was performed hysteroscopically with Gubbini’s hysteroscope. Results: In 100% of the cases an isthmocele grade 2 or 3 was diagnosed by ultrasound. The minimal thickness of the myometrium above the isthmocele had to be at least 3mm. In 39/39 patients the hysteroscopic procedure was performed without any complications on an outpatient basis. The patients were dismissed two hours after the procedure. The correction of the defect was associated with the improvement of symptoms in all patients. Conclusions: A myometrium of more or equal to 3 mm seemed to be sufficient for safely hysteroscopic treatment of isthmoceles of all severity grades in outpatients. OC17.06 2D-TVU is a more accurate modality than 3D-VCI in staging endometrial cancer R.W. Green3, L. Valentin5, J. Alcázar9, T. Van den Bosch6, V. Chiappa4, B. Erdodi8, D. Franchi1, P. Fruhauf10, R. Fruscio11, S. Guerriero7, B. Graupera2, A. Jakab8, A. Di Legge12, M. Ludovisi12, F. Mascilini13, M. Pascual2, E. Epstein3 1European Institute of Oncology, Milano, Italy; 2Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain; 3Department of Women’s and Children’s Health, Karolinska Institute, Solna, Sweden; 4Gynecologic Oncology, National Cancer Institute of Milan, Milan, Italy; 5Skåne University Hospital, Malmo, Sweden; 6Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium; 7Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy; 8Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary; 9Obstetrics and Gynecology, University of Navarra, Pamplona, Spain; 10Onkogynekologicke Centrum, Gynekologicko-Porodnicka Klinika, Prague, Czech Republic; 11Clinica Ostetrica e Ginecologica, Ospedale San Gerardo, Monza, Italy; 12Division of Gynecologic Oncology, Catholic University of Sacred Heart, Rome, Italy; 13Centro di Ecografia in Ginecologia, Fondazione Policlinico Universitario Gemelli, Rome, Italy Objectives: To compare diagnostic accuracy of transvaginal (TVS) video clip and 3D-volume contrast imaging (VCI) off-line assessment in endometrial cancer (EC) staging. Methods: Fifteen gynecologists, with a median of 7 years experience (range 2–22) in EC staging, assessed off-line de-identified TVS video clips and 3D-VCI volumes regarding presence/absence of deep (≥50%) MI and/or CSI in the same set of patients. The patient material was collected from 58 women, with biopsy confirmed EC, examined by a single examiner (consecutive cases, selecting cases to achieve an adequate mix of deep MI (n=22) and CSI (n=9)). Pathological examination after hysterectomy served as ‘gold standard’. Diagnostic accuracy was measured using overall accuracy, sensitivity and specificity and Cohen’s and Fleiss’ kappa when compared to the ‘gold standard’. Kappa (κ) values were denoted ‘Poor’ (≤0.2), ‘Fair’ (0.21–0.4), ‘Moderate’ (0.41–0.6), ‘Good’ (0.61–0.8) and ‘Very good’ (0.81–1). Results: Table 1 shows the diagnostic accuracy measurements for deep MI with TVU and 3D-VCI. For TVU Cohen’s κ was ‘Poor’-‘Fair’ for 3/15 (20%) and ‘Moderate’-’Good’ for 12/15 (80%), with a ‘Moderate’ Fleiss’ κ of 0.41. For 3D-VCI Cohen’s κ was ‘Poor’-‘Fair’ for 10/15 (67%), ‘Moderate’-‘Good’ in 5/15 (33%), with a ‘Fair’ Fleiss’ κ of 0.31. In diagnosing CSI with TVS Cohen’s κ was ’Fair’ for 1/15 (7%) and ‘Moderate’-‘Good’ for 14/15 (93%), with a ‘Moderate’ Fleiss’ κ of 0.55. With 3D-VCI Cohen’s κ was ‘Poor’-’Fair’ in 4/15 (27%) and ‘Moderate’-‘Good’ in 11/15 (73%), with a ‘Moderate’ Fleiss’ κ of 0.45. Conclusions: For the off-line assessment of deep MI and CSI in women with EC, TVS video-clips provide a higher accuracy than 3D-VCI. Supporting information can be found in the online version of this abstract © The Authors 2017 36 © Ultrasound in Obstetrics & Gynecology 2017; 50 (Suppl. 1): 1–47.