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 accu-racy, 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 work-ing 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 diagnosticmethodsand, more specifically, oftheir characteristics with the use of the experts panel consensus method and of their diagnostic accuracyperforming a systematic review of evi-dence and (2) consensus for (a) the definition of where and how to measure uterine wall thickness and (b) the recommen-dations for the diagnostic work-up of female genital anoma-lies, based on the results of the previous evaluation proce-dure, 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 thick-ness 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 suspectedtohaveananomaly from routine avaluation. Magnetic resonance imaging (MRI) and endoscopic evalua-tion 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 diag-nostic 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 hyster-oscopy should be prospectively evaluated. It is a challenge for further research, based on diagnosis, to objectively eval-uate the clinical consequences related to various degrees of uterine deformity