Use of strict sonohysterographic methods for preoperative assessment of submucous myomas

Abstract

Objective To assess the diagnostic accuracy of sonohysterography (SHG) and transvaginal sonography versus diagnostic hysteroscopy in preoperative assessment of submucous myomas. Design Prospective pilot study. Setting University hospital outpatient center. Patient(s) Forty-eight symptomatic (bleeding, infertility) premenopausal patients with submucous myomas. Intervention(s) Preoperative grading of submucous myomas with a strict SHG methodology and standard transvaginal sonography compared with hysteroscopic grading of submucous myoma before hysteroscopic myomectomy. Main outcome measure(s) SHG and sonographic agreement with hysteroscopic findings. Result(s) Forty-eight patients were enrolled (mean age ± SD = 41 years ± 10.2). The median duration of SHG was 12 minutes (interquartile range, 9–16). The mean number of submucous myomas was 1 (range, 1–3) per woman. In all cases, a successful SHG was performed, with no, mild, or moderate pain in 38 (79%), 8 (17%), and 2 (4%) patients, respectively. No patients experienced severe pain or vasovagal reaction. All cases were correctly diagnosed by SHG compared with the final hysteroscopic diagnosis (κ = 1.0; SE = 0.105). Simple transvaginal ultrasound was inaccurate in six cases (κ = 0.81; SE = 0.103). Conclusion(s) Strict and reproducible SHG diagnostic procedures proved to be as effective as hysteroscopy and well tolerated in preoperative grading of submucous myomas.