Comparison of Different Classification Systems for Müllerian Duct Anomalies: A Retrospective Observational MRI Study

Area of Science:

• Reproductive Medicine
• Medical Imaging
• Gynecological Surgery

Background:

• Müllerian duct anomalies (MDAs) are congenital female genital tract malformations.
• Several classification systems exist, but their diagnostic consistency is unclear.

Purpose of the Study:

• To evaluate the interrater reliability of four major MDA classification systems: American Fertility Society (AFS), European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), American Society for Reproductive Medicine (ASRM), and Congenital Uterine Malformation by Experts (CUME).

Main Methods:

• Retrospective cohort study of 71 patients (≤45 years) with MDAs.
• Independent evaluation of pelvic MRI scans by four readers.
• Assessment of interrater reliability using Krippendorff's alpha and analysis of indeterminate/unclassifiable cases.

Main Results:

• All four MDA classification systems demonstrated very low interrater reliability.
• The AFS system had an alpha of 0.63, ASRM 0.46, ESHRE/ESGE 0.33, and CUME 0.57.
• The ESHRE/ESGE system yielded the most indeterminate cases (9.9%), while the ASRM system had the most unclassifiable cases (20.6%).

Conclusions:

• Existing MDA classification systems lack sufficient interrater reliability for consistent diagnosis.
• Recommendations are provided for improving current systems.
• Future research should focus on a single, unified classification system with clinically relevant parameters for improved patient reproductive outcomes.