Sonohysterographic staging of submucous myomas

Abstract

Purpose: To assess the diagnostic accuracy of sonohysterography in preoperative assessment of submucous myomas.Methods: Twenty premenopausal patients with submucous myomas and irregular uterine bleeding and/or infertility were consecutively collected in 12 months. Before surgery, all patients underwent transvaginal sonography (TVS) (Voluson, KRETZ, 5300), with color Doppler evaluation, and sonohysterography (SHG). Number and site of myomas and the myoma–perimetrium distance were considered at TVS. SHG was performed with a 4.7‐mm (14F) intrauterine catheter. Patient compliance to SHG was evaluated by a subjective pain scale. Duration from TVS to completion of the procedure, and volume of saline solution instilled for SHG, were evaluated. Sonographic findings at TVS and SHG were classified as submucous myoma G0, G1 and G2 and compared to hysteroscopic finding. Depending on myoma grading and volume, selected patients underwent preoperative medical treatment with triptorelin (decapeptyl‐ipsen). Hysteroscopic myomectomy was the standard surgical approach. Diagnostic accuracy of TVS and SHG was evaluated.Results: Mean age was 41 years (interquartile range 34–47). Mean BMI was 24 kg/m2 (interquartile range 21–28). Twelve patients reported irregular bleeding, eight infertility. Eleven patients had additional intramural and or subserous myomas. Mean duration time of SHG was 12 min (interquartile range 9–16). Mean volume of sterile solution instilled for SHG was 16 mL (interquartile range 8–24). In all cases, a successful SHG was performed, with no and mild discomfort in 16 (80%) and 3 (11%) patients, respectively. Hysteroscopic findings were compared to TVS and SHG considering the submucous myoma grading. SHG correctly classified all miomas (five cases of G0, 11 cases of G1, five cases of G2). TVS correctly classified all G0 cases, over classified two G1 cases as G2, correctly classified five cases of G2.Conclusions: Sonohysterography was a simple and well tolerated imaging technique, with a diagnostic accuracy comparable to hysteroscopy. We speculate that endometrial sampling performed during SHG could help to exclude coexisting endometrial abnormalities which are likely to occur in larger series.