P127: Sonohysterography and endometrial sampling in the pre-operative assessment of submucous myomas

Abstract

To determine the role of sonohysterography (SHG), associated with endometrial sampling, in the pre-operative assessment of submucous myomas and associated endometrial abnormalities. 64 symptomatic (bleeding) pre-menopausal patients with submucous myomas were recruited. All patients underwent transvaginal sonography (TVS) and SHG (Technos MP, Esaote). Number, volume and site of myomas and the myoma-perimetrium distance were considered at TVS. SHG with endometrial sampling was performed with a 4.7 mm (14F) intrauterine catheter. Patient compliance to SHG was evaluated by a subjective pain scale. Submucous myoma were classified at SHG as G0, G1 and G2 and compared to final hysteroscopic finding. Depending on hystologic findings at endometrial sampling, selected patients received pre-operative medical treatment. Hysteroscopic myomectomy was the standard surgical approach. Mean age (± sd) of the enrolled patients was 41 years ± 6.6. Median myoma volume was 4 cc (interquartile range 2–10). Overall 74 submucous myomas were examined. Twenty-five (39%) patients had additional intramural and or subserous myomas. Moderate or severe pain was experienced in 5 patients (8%). At hysteroscopy, submucous myomas were classified as G0, G1 and G2 in 17, 35 and 22 cases, respectively. All 72 cases with one submucous myoma were correctly diagnosed by sonohysterography compared to the final hysteroscopic diagnosis. In two patients with large (> 5 cc) and multiple submucous SHG misclassified one G1 and one G2 cases. Simple endometrial hyperplasia at endometrial sampling was found in nine patients. This finding allowed for completing surgical with medical treatment. Sonohysterography proved to be effective and well tolerated and in pre-operative assessment of submucous myomas. Endometrial sampling performed during SHG could help to identify coexisting endometrial abnormalities and the need for medical treatment.