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Open Access 01-02-2016 | Opinion

The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies

Authors: Grigoris F. Grimbizis, Attilio Di Spiezio Sardo, Sotirios H. Saravelos, Stephan Gordts, Caterina Exacoustos, Dominique Van Schoubroeck, Carmina Bermejo, Nazar N. Amso, Geeta Nargund, Dirk Timmermann, Apostolos Athanasiadis, Sara Brucker, Carlo De Angelis, Marco Gergolet, Tin Chiu Li, Vasilios Tanos, Basil Tarlatzis, Roy Farquharson, Luca Gianaroli, Rudi Campo

Published in: Gynecological Surgery | Issue 1/2016

Abstract

What is the recommended diagnostic work-up of female genital anomalies according to the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) system? The ESHRE/ESGE consensus for the diagnosis of female genital anomalies is presented. Accurate diagnosis of congenital anomalies still remains a clinical challenge due to the drawbacks of the previous classification systems and the non-systematic use of diagnostic methods with varying accuracy, with some of them quite inaccurate. Currently, a wide range of non-invasive diagnostic procedures are available, enriching the opportunity to accurately detect the anatomical status of the female genital tract, as well as a new objective and comprehensive classification system with well-described classes and sub-classes. The ESHRE/ESGE Congenital Uterine Anomalies (CONUTA) Working Group established an initiative with the goal of developing a consensus for the diagnosis of female genital anomalies. The CONUTA working group and imaging experts in the field have been appointed to run the project. The consensus is developed based on (1) evaluation of the currently available diagnostic methods and, more specifically, of their characteristics with the use of the experts panel consensus method and of their diagnostic accuracy performing a systematic review of evidence and (2) consensus for (a) the definition of where and how to measure uterine wall thickness and (b) the recommendations for the diagnostic work-up of female genital anomalies, based on the results of the previous evaluation procedure, with the use of the experts panel consensus method. Uterine wall thickness is defined as the distance between interostial line and external uterine profile at the midcoronal plane of the uterus; alternatively, if a coronal plane is not available, the mean anterior and posterior uterine wall thickness at the longitudinal plane could be used. Gynaecological examination and two-dimensional ultrasound (2D US) are recommended for the evaluation of asymptomatic women. Three-dimensional ultrasound (3D US) is recommended for the diagnosis of female genital anomalies in “symptomatic” patients belonging to high-risk groups for the presence of a female genital anomaly and in any asymptomatic woman suspected to have an anomaly from routine avaluation. Magnetic resonance imaging (MRI) and endoscopic evaluation are recommended for the sub-group of patients with suspected complex anomalies or in diagnostic dilemmas. Adolescents with symptoms suggestive for the presence of a female genital anomaly should be thoroughly evaluated with 2D US, 3D US, MRI and endoscopy. The various diagnostic methods should be used in a proper way and evaluated by experts to avoid mis-, over- and underdiagnosis. The role of a combined ultrasound examination and outpatient hysteroscopy should be prospectively evaluated. It is a challenge for further research, based on diagnosis, to objectively evaluate the clinical consequences related to various degrees of uterine deformity.

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Title: The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies
Authors: Grigoris F. Grimbizis
Attilio Di Spiezio Sardo
Sotirios H. Saravelos
Stephan Gordts
Caterina Exacoustos
Dominique Van Schoubroeck
Carmina Bermejo
Nazar N. Amso
Geeta Nargund
Dirk Timmermann
Apostolos Athanasiadis
Sara Brucker
Carlo De Angelis
Marco Gergolet
Tin Chiu Li
Vasilios Tanos
Basil Tarlatzis
Roy Farquharson
Luca Gianaroli
Rudi Campo
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: Gynecological Surgery / Issue 1/2016
Print ISSN: 1613-2076
Electronic ISSN: 1613-2084
DOI: https://doi.org/10.1007/s10397-015-0909-1

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The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies

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