Abstract
BackgroundTo determine the accuracy of measurement of internal indentation length on transvaginal 3D ultrasound scan (TV 3D US) in detecting patients with an incomplete uterine septum (IUS) or a significant arcuate uterine anomaly (AUA) based on the actual length as measured on diagnostic hysteroscopy. We compared the mean internal indentation length on TV 3D US and on diagnostic hysteroscopy in patients with IUS or a significant AUA.ResultsThis is a retrospective study of 546 patients who were found to have IUS (134) or significant AUA (412) on diagnostic hysteroscopy and who had TV 3D US prior to surgery. The mean internal indentation length measured in millimeter on hysteroscopy was significantly higher than the mean internal indentation length measured on TV 3D US in patients with IUS (16.7 + 5.5 vs 5.5 + 4.2; P < 0.001), in patients with significant AUA (12.9 + 2.8 vs 3.9 + 4.6; P < 0.001), and in the overall population (13.8 + 4.0 vs 4.3 + 4.5; P < 0.001). The same findings were obtained when the comparison was limited to patients who had moderate significant internal indentation length (10–14 mm) and those with significant internal indentation length (15–25 mm).ConclusionData in this study suggests that the mean internal indentation length in patients with IUS or AUA can be underestimated on TV 3D US. A diagnostic hysteroscopy is the only gold standard to make the correct diagnosis in these patients.
Highlights
To determine the accuracy of measurement of internal indentation length on transvaginal 3D ultrasound scan (TV 3D Transvaginal 3D ultrasound scan (US)) in detecting patients with an incomplete uterine septum (IUS) or a significant arcuate uterine anomaly (AUA) based on the actual length as measured on diagnostic hysteroscopy
The purpose of this study is to determine the accuracy of measurement of an indentation length at the fundal midline (IILFM) on TV 3D US with or without saline infusion hysterogram (SIH) in detecting patients with an IUS or a significant AUA that was diagnosed on diagnostic hysteroscopy based on the actual IILFM
The mean IILFM measured in millimeter on hysteroscopy was significantly higher than the IILFM measured on TV 3D US with or without SIH, in patients with IUS (16.7 + 5.5 vs 5.5 + 4.2; P < 0.001), in patients with significant AUA (12.9 + 2.8 vs 3.9 + 4.6; P < 0.001), and in the overall population (13.8 + 4.0 vs 4.3 + 4.5; P < 0.001) (Fig. 4)
Summary
To determine the accuracy of measurement of internal indentation length on transvaginal 3D ultrasound scan (TV 3D US) in detecting patients with an incomplete uterine septum (IUS) or a significant arcuate uterine anomaly (AUA) based on the actual length as measured on diagnostic hysteroscopy. The new guidelines by ASRM define AUA as a uterus with a “depth from the interstitial line to the apex of the indentation < 1 cm and angle of the indentation > 90°” [30] This new definition does not take into account patients with arcuate appearance and an internal indentation length ≥ 1 cm [30]. The new classification of Müllerian anomalies proposed by the European Society of Human Reproduction and Embryology and the European Society for Gynecological Endoscopy (ESHREESGE) do not differentiate between AUA and uterine septum. Instead they adopted a definition of uterine septum, if there is an IILFM > 50% of myometrial wall thickness [12]. The authors of this report recommended considering indentation depth ≥ 10 mm as septate, and this criterion is in agreement with expert opinion [22]
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