Intra- and Inter-Rater Agreement Describing Myometrial Lesions Using Morphologic Uterus Sonographic Assessment: A...

Area of Science:

• Reproductive Medicine
• Medical Imaging
• Gynecologic Ultrasound

Background:

• Accurate characterization of myometrial lesions is crucial for diagnosis and management.
• Standardized terminology, such as Morphologic Uterus Sonographic Assessment (MUSA), aims to improve consistency in ultrasound reporting.
• Evaluating the reliability of such terminology is essential for its clinical adoption.

Purpose of the Study:

• To assess the intra- and inter-rater agreement for identifying and characterizing myometrial lesions using MUSA terminology.
• To determine the reliability of MUSA terminology in differentiating between well-defined and poorly defined myometrial lesions.

Main Methods:

• Thirteen sonographers (6 high, 7 medium experience) evaluated 30 3D ultrasound clips of myometrial lesions.
• Lesions were classified as poorly or well-defined and individual features were assessed.
• Assessments were performed twice by each rater at a 2-month interval, with agreement calculated using kappa statistics.

Main Results:

• Good to very good intra- and inter-rater agreement was observed for well-defined lesions (κ=0.63–0.82).
• Moderate intra-rater and poor inter-rater agreement were found for poorly defined lesions (κ=0.25–0.49).
• Agreement on individual features varied, with lower reproducibility for features of ill-defined lesions (e.g., myometrial cysts, translesional flow).

Conclusions:

• MUSA terminology demonstrates good reliability for well-defined myometrial lesions but shows low agreement for poorly defined lesions.
• The reproducibility of specific sonographic features, particularly those associated with ill-defined lesions, needs improvement.
• Developing clear guidelines for interpreting features of ill-defined lesions could enhance diagnostic consistency.