Comparison of image-based modified Ferriman-Gallway score evaluation with in-person evaluation: an alternative method for hirsutism diagnosis

The gold standard for diagnosing hirsutism is based on the modified Ferriman-Gallway (mFG) score, requiring trained and in-person evaluation. Our study aimed to evaluate whether using mobile phone images of the nine mFG areas could offer an alternative way to support the diagnostic of hirsutism. All patients from an endocrine outpatient clinic underwent an initial mFG evaluation by two blinded, trained examiners. Then, images of the nine mFG areas were acquired using a mobile device (48 MP) under standard conditions and artificial illumination. A cutoff mFG score of ≥ 4 (suggested by European Society of Human Reproduction and Embryology) or ≥ 6 (proposed by The Endocrine Society) has been established as the criteria for diagnosing hirsutism. After storage, the individual patients’ images were submitted for mFG analysis by three independent, blinded examiners. Overall, 70 females were evaluated; 27.5% of the patients had an mFG score ≥ 4. The mean age ± SEM was 33.2 + 1.13 years. The first consideration was the evaluation of the examiners who analyzed the images. In this group, the inter-rater reliability based on the Fleiss’ Kappa identified an agreement of 81.4%, with a Kappa index of 0.75 considered strong for clinical evaluations. For mFG score ≥ 6, the agreement was 77%, and the performance of Kappa Index was 0.62 (moderate). Independently of the cutoffs, the Bland–Altman analysis established a concordance of 0.89 (95% CI [0.83, 0.92]) between the in-person and image-based methods to score mFG. The lower limit of agreement of the estimated mFG scores was − 2.08 (95% CI [− 2.73, − 1.43]), and the upper limit of agreement was 4.14 (95% CI [3.491, 4.79]). We observed acceptable concordance between the image-based and in-person evaluation of mFG scores. Our results support the use of image acquisition of mFG areas as a valid approach for diagnosing hirsutism.