Reproducibility of Saline Contrast Sonohysterography for the Detection of Intracavitary Abnormalities in Women with Abnormal Uterine Bleeding

Objectives: Saline contrast sonohysterography (SCSH) is a diagnostic test for the examination of intracavitary abnormalities. The objective of this study was to calculate interobserver and intraobserver agreement for the interpretation of video recordings of SCSH procedures according to different levels of experience.

Methods: SCSH examinations were carried out by an operator experienced at performing SCSH and were recorded on video. To assess interobserver and intraobserver agreement, video material was scored by observers allocated to different groups according to their level of experience. Observers who had performed 25 or more SCSH procedures were defined as experienced (Group A), those who had carried out 1-24 as less experienced (Group B), and those with no experience of performing SCSH as inexperienced (Group C). All observers were blinded to the case histories of the patients.

Results: There was a significant difference in kappa values for interobserver agreement between the most experienced group and the less experienced observers. Group A, with the highest level of experience, had a mean kappa value of 0.62 (95% CI, 0.56-0.67), compared with 0.38 (95% CI, 0.33-0.43) in Group B and 0.47 (95% CI, 0.43-0.52) in Group C. The interobserver agreement in Group A was significantly higher than that in Groups B and C (P < 0.001 and P = 0.023, respectively), and Group C performed better than Group B (P = 0.024). Intraobserver agreement (n = 7) was good, with a mean kappa value of 0.66 (Group A, 0.63; Group C, 0.71).

Conclusions: Interobserver agreement in interpretation of video recordings of SCSH by inexperienced sonographers is poor, whereas the intraobserver agreement is good. We consider the poor interobserver agreement to be due to non-uniform diagnostic criteria. Uniform diagnostic criteria for SCSH should be incorporated into the training of residents and other physicians performing these examinations.