Accuracy of transvaginal ultrasound, saline infusion sonohysterography, and office hysteroscopy in the diagnosis of endometrial polyps

A Andrisani,A Vitagliano,F Dessole,G Ambrosini,G Capobianco,G Virdis,L Marin,R Cappadona,S Dessole

doi:10.12891/ceog5084.2019

Abstract

Background: Endometrial polyps (EPs) derive from overgrowths of stromal or endometrial glands supported by a fibrovascular core. Currently, there is no clear recommendation on the first-line tool to be employed between sonohysterography (SIS) and office hysteroscopy (ISC) in the evaluation of patients with the suspect of EPs. Materials and Methods: The authors performed a retrospective study on consecutive patients referred at their Unit with a suspicion of EP at transvaginal sonography (TVS). A total number of 1,243 patients were subject to TVS and ISC, while 128 ones were subject to TVS, SIS, and ISC. Primary outcome was the evaluation of the diagnostic performance of SIS and ISC in the detection of EPs. Results: ISC allowed the identification of EPs in all the cases (n=128/128 patients), with a sensitivity of 100% and specificity of 98%. For SIS, the sensitivity was 97% (n=124/128 patients) and specificity was 90%. Conclusions: ISC showed better diagnostic accuracy in comparison to SIS. Due to high diagnostic accuracy and the possibility to “see and treat” EPs in a single step, ISC should be considered as the gold standard approach in women with a suspect of EPs.

Highlights

Endometrial polyps (EPs) derive from a focal or multifocal overgrowth of stromal and endometrial glands supported by a fibrovascular core [1]
When they manifest with abnormal uterine bleeding (AUB), the bleeding symptom can be accompanied by pelvic pain caused by uterine contractions, especially when the EP is large [2, 4]
ISC allowed the identification of EPs in all the cases (n=128/128 patients), with a sensitivity of 100% and a specificity of 98%

Summary

Introduction

Endometrial polyps (EPs) derive from a focal or multifocal overgrowth of stromal and endometrial glands supported by a fibrovascular core [1]. They can be single or multiple and can vary from a few millimeters to some centimeters, typically developing in the upper-third of the uterine cavity or in the fundal region [2, 3]. EPs have a reddish-yellow color with a translucent appearance and may exhibit localized necrotic and/or hemorrhagic areas [1, 3]. They are classified according to their histological composition in adenomatous EPs (i.e. with greater glandular component) and fibrous EPs (i.e. with a major fibrous component) [4]. When they manifest with AUB, the bleeding symptom can be accompanied by pelvic pain caused by uterine contractions, especially when the EP is large [2, 4]

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