Comparison of different diagnostic procedures for the staging of malformations associated with Mayer-Rokitansky-Kuster-Hauser syndrome.

摘要

OBJECTIVE: To compare different diagnostic procedures for staging malformations associated with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. DESIGN: Retrospective two-center cohort study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENT(S): One hundred and thirty-eight women with MRKH. INTERVENTION(S): Clinical examinations, abdominal or perineal/rectal ultrasound, magnetic resonance imaging (MRI), and laparoscopy. MAIN OUTCOME MEASURE(S): Agreement between the results obtained with the other methods and the results obtained with the reference methods for correct staging of malformations, presented as kappa values (kappa). RESULT(S): The VCUAM (vagina cervix uterus adnex-associated malformation) classification system was used to classify genital malformations in 138 women with MRKH. The reference methods for examining the individual organs were: vagina-clinical examination; cervix/uterus and adnexa-laparoscopy; and urinary tract malformations-MRI. The values obtained were as follows. Vagina was kappa 0.74 for MRI versus clinical examination; ultrasound and laparoscopy did not allow adequate description of vaginal malformations. Cervical findings were rarely detailed with any of the imaging methods. Uterus was kappa 0.93 for MRI versus laparoscopy, and kappa 0.83 for ultrasound. For adnexa, only laparoscopy was able to describe the morphology adequately. The urinary tract was kappa 0.87 for ultrasound versus MRI. CONCLUSION(S): For the correct staging of malformations associated with MRKH, MRI or a combination of clinical examination and ultrasound are equivalent. However, none of the imaging methods adequately describes adnexal morphology.