Detection Of Endometrial Polyps Research Articles

Diagnostic Accuracy of Transvaginal Sonography in the Detection of Endometrial Polyps

Background: Transvaginal sonography (TVS) is considered a simple and generally accepted method for detecting uterine anomalies. With TVS, the uterus can be clearly visualized, but so far, the diagnostic accuracy of TVS varies across different studies. This retrospective study was devised to evaluate the accuracy of a sonographic diagnosis of endometrial polyps in a Ukrainian hospital. Methods: This was a single-center retrospective study of woman who underwent TVS and had hysteroscopy or dilation and curettage for endometrial pathology. A cohort of 156 women were included in this yearlong study. A comparative analysis was based on the preoperative diagnosis, according to TVS, compared with the postoperative histopathology results. Results: The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of TVS in diagnosing endometrial polyps were 69%, 51%, 73%, 46%, and 63%, respectively. Conclusion: This retrospective study provided data on the lack of accuracy for a sonographic diagnosis of endometrial polyps. This was based on 26% of women whose diagnosis was not confirmed by histology. A false-negative result occurred for 54% of women who had polyps that were not detected at the preoperative stage. These data raise the question of the feasibility of further invasive procedures based on a single TVS study.

Diagnosing Polyps on Transvaginal Sonography: Is Sonohysterography Always Necessary?

Endometrial polyps are localized overgrowth of glands, stroma, and blood vessels and reported in 13% to 50% of women with dysfunctional uterine bleeding. Transvaginal ultrasound (TVUS) is the initial noninvasive modality of choice for the evaluation of endometrial polyps. The addition of intrauterine contrast by adding saline during saline infusion sonohysterography (SIS) has been reported to improve diagnostic accuracy in detecting of endometrial polyps. Given all the technical advances in ultrasound instrumentation and technology over the last 10 years, we wanted to revisit the diagnostic accuracy and associated confidence level of TVUS and SIS for detecting endometrial polyps. The aims of this study was to determine the diagnostic accuracy of TVUS in detecting endometrial polyps in patients with abnormal uterine bleeding or infertility and to determine if SIS is necessary when the level of confidence that a polyp is present is high. A total of 144 patients who underwent both TVUS and SIS for the evaluation of abnormal uterine bleeding and infertility were retrospectively identified and independently reviewed by 2 blinded readers. Examinations were graded as polyps absent, equivocal for polyps, and polyps definitely present. Interreader agreement for TVUS grade was assessed using Cohen kappa. Hysteroscopy and histopathology were used as the reference standard for the final diagnosis. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated, and confidence intervals (CIs) were computed. From the combined assessments of both readers (288 reads), 24.7% were definitively positive for polyps, 47.2% were negative, and 28.1% were equivocal by TVUS. Interreader agreement was good with a kappa of 0.66 (95% CI, 0.56-0.76). Among the 108 reads where hysteroscopy/histopathology results were available, even when diagnostic confidence for the presence of polyps was high, TVUS had a PPV of 65.2% (95% CI, 42.1%-88.9%). This PPV was significantly lower than the corresponding PPV of SIS of 88.5% (95% CI, 77.4-100.0%; P = 0.021 for the difference). Saline infusion sonohysterography has better diagnostic accuracy for the detection and exclusion of endometrial polyps than TVUS, even in cases where the diagnostic confidence for the presence of polyps is high. Saline infusion sonohysterography may still be needed to confirm a TVUS diagnosis for polyps to limit the number of negative hysteroscopies.

Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding: systematic review and meta-analysis.

To analyze the diagnostic accuracy of two- (2D) and three- (3D) dimensional saline contrast sonohysterography (SCSH) in the detection of endometrial polyps and submucosal uterine leiomyomas in women of reproductive age with abnormal uterine bleeding compared with gold standard hysteroscopy. A systematic review of diagnostic studies that compared 2D- and/or 3D-SCSH with hysteroscopy and anatomopathology was conducted according to PRISMA and SEDATE recommendations. The databases MEDLINE, EMBASE and The Cochrane Library were searched electronically using specific terms with no restriction on language or publication year. Quality assessment of included studies was performed using the QUADAS-2 tool. Meta-analysis was performed with the Meta-DiSk program and data presented as forest plots and summary receiver-operating characteristics (SROC) curves. Pooled sensitivity, specificity and positive (LR+) and negative (LR-) likelihood ratios of SCSH in the detection of uterine cavity abnormalities were calculated. A total of 1398 citations were identified and five studies were included in the systematic review and meta-analysis. Pooled sensitivity and specificity of 2D-SCSH in detecting endometrial polyps were 93% (95% CI, 89-96%) and 81% (95% CI, 76-86%), respectively, with pooled LR+ of 5.41 (95% CI, 2.60-11.28) and LR- of 0.10 (95% CI, 0.06-0.17). In the detection of submucosal uterine leiomyomas, pooled sensitivity and specificity were 94% (95% CI, 89-97%) and 81% (95% CI, 76-86%), respectively, with pooled LR+ of 4.25 (95% CI, 2.20-8.21) and LR- of 0.11 (95% CI, 0.05-0.22). 2D-SCSH had good accuracy in detecting endometrial polyps and submucosal uterine leiomyomas, with areas under the SROC curves of 0.97 ± 0.02 and 0.97 ± 0.03, respectively. Studies that analyzed the diagnostic accuracy of 3D-SCSH could not be compared due to high heterogeneity related to menopausal status, type of technique used and primary outcome being investigation of infertility. 2D-SCSH proved to be a highly sensitive method for detection of endometrial polyps and submucosal uterine leiomyomas, making it a potential first-line diagnostic method in the work-up for women with abnormal uterine bleeding. More studies are needed on 3D-SCSH in women of reproductive age. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Evaluation of transvaginal sonography in detecting endometrial polyps and the pregnancy outcome following hysteroscopic polypectomy in infertile women.

The aims of the present study were to evaluate the effectiveness of transvaginal sonography (TVS) in the detection of endometrial polyps (EPs), and to assess the pregnancy outcome in infertile women following hysteroscopic polypectomy. A total of 145 women diagnosed with primary or secondary infertility and intrauterine disorders by TVS and hysterosalpingography (HSG) were included in the current study. All subjects were divided into three groups based on hysteroscopic findings, including the EP, intrauterine adhesion and normal groups. EPs were removed for biopsy and intrauterine adhesions were treated. Pregnancy rates between groups were compared. In total, 34 EPs were detected by TVS, while 45 subjects were later confirmed with EP by hysteroscopy. The sensitivity, specificity, positive predictive value and negative predictive value of TVS in the detection of EPs were 67, 96, 88.23 and 86.49%, respectively. Of the included patients, 120 subjects were followed up, including 40 patients diagnosed with EPs, 42 with intrauterine adhesions and 38 with normal cavities. The results indicated no statistically significant differences in the age, type and duration of infertility, least function (LF) score and classification of the extent of tubal disease with the distal fimbrial obstruction between the three groups. In addition, pregnancy rate and spontaneous abortion rate in the EP group following hysteroscopic polypectomy were 45 and 5.6%, respectively. No significant difference was observed in the fertility rate following surgery. In conclusion, TVS features high sensitivity, specificity and certain unique sonographic characteristics in diagnosing EPs, and may be used as a preliminary diagnostic procedure to select patients for hysteroscopy. Furthermore, hysteroscopic polypectomy is an important approach for the treatment of infertile patients with EPs and appears to help increase the pregnancy rate of previously infertile women.

Three-dimensional sonohysterography may replace hysteroscopy for women with perimenopausal bleeding

Objective To investigate whether three-dimensional saline-infusion transvaginal sonohysterography can replace hysteroscopy in the detection of intrauterine lesions in women with perimenopausal bleeding.Materials and methods This study was carried out at the Department of Obstetrics and Gynecology, Menofyia University Hospital in Egypt. Fifty women who presented with perimenopausal bleeding and fulfilled the inclusion criteria were recruited for the study. Three-dimensional sonohysterography was performed followed by hysteroscopy for all women. Results were tabulated and statistically analyzed. The accuracy of both techniques was calculated in terms of sensitivity, specificity, positive and negative predictive values.Results The mean age of women enrolled was 47.5 ± 5.61 years and the mean body mass index was 28.13 ± 2.91 kg/m2. Three-dimensional sonohysterography detected no abnormality in 26 women but hysteroscopy only detected 24 with no abnormality. Compared to hysteroscopy, three-dimensional sonohysterography has sensitivities of 100% and 92% in the detection of endometrial polyps and submucous fibroids, respectively. The specificity of sonohysterography for both lesions was 100%. The sensitivity and specificity for other lesions exceeded 95%.Conclusions Three-dimensional sonohysterosonography may be considered as an effective alternative to hysteroscopy in the assessment of the uterine cavity for any woman with perimenopausal bleeding.

P11.03: Diagnostic accuracy of transvaginal sonogarphy in infertile patients with endometrial polyp

Background: To evaluate the diagnostic accuracy of transvaginal sonography (TVS) in infertile patients and compare its results with hysteroscopy, as the gold standard. Materials and Methods: A total of 679 infertile women who underwent both TVS and diagnostic hysteroscopy were retrospectively investigated. TVS was performed in the mid-follicular phase (days 5-8) of their cycles. Sensitivity, specificity, and positive and negative predictive values were calculated for TVS. Results: Hysteroscopy diagnosed endometrial polyps in 197 out of 679 cases (24.5%). TVS confirmed the hysteroscopy findings in 174 of 197 (88.3%) cases. The sensitivity, specificity, and positive and negative predictive values of TVS compared to hysteroscopy in the detection of endometrial polyps were 88.3%, 91.9%, 81.6% and 90.8%, respectively. Conclusion: TVS is both a cost-effective and non-invasive method for the diagnosis of intrauterine lesions such as polyps. When used in conjunction with a saline infusion, it can be a proper alternative for diagnostic hysteroscopy that saves time and enables the surgeon to perform the operative hystroscopy procedure with greater accuracy.

P27.08: Can we rely on transvaginal ultrasonography in the detection of endometrial polyps? A comparison of transvaginal ultrasonography, hysteroscopy and pathology reports.

P27.08: Can we rely on transvaginal ultrasonography in the detection of endometrial polyps? A comparison of transvaginal ultrasonography, hysteroscopy and pathology reports.

Transvaginal saline hysterosonography: a comparison with local anaesthetic hysteroscopy for the diagnosis of benign lesions associated with menorrhagia

The objective of this paper is to assess the diagnostic accuracy of transvaginal saline hysterosonography (TVHSg) compared to hysteroscopy in the identification of benign lesions affecting the endometrium in women with menorrhagia. A cross-sectional study was reported according to the Standards for Reporting of Diagnostic Accuracy (STARD) guidelines. These standards were introduced by an international steering committee in order to improve the reporting of diagnostic accuracy studies. The study was carried out at a one-stop menorrhagia clinic at a central teaching hospital in Newcastle Upon Tyne, UK. One hundred and forty patients were referred to the menorrhagia clinic. After clarification of their history, TVHSg was performed on each patient and the findings were recorded on a proforma. The patients then underwent hysteroscopy using local anaesthetic and a Pipelle endometrial biopsy was performed. Each operator was blinded to the findings of the preceding investigation until both proformas had been completed. The diagnostic accuracy of TVHSg was compared to hysteroscopy in the diagnosis of benign intrauterine lesions. TVHSg has a sensitivity of 0.88, a specificity of 0.99, a positive predictive value of 0.96, a negative predictive value of 0.97 and a positive likelihood ratio of 99 in the detection of endometrial polyps. For the detection of submucous fibroids, the sensitivity is 0.86, the specificity is 0.98, the positive predictive value is 0.90, the negative predictive value is 0.97 and the positive likelihood ratio is 49. We conclude that TVHSg has high diagnostic accuracy for the detection of intracavitary lesions in patients with menorrhagia when compared to out-patient hysteroscopy.

OC101: The detection of endometrial polyps, the contribution of hysterosonography and colour Doppler

OC101: The detection of endometrial polyps, the contribution of hysterosonography and colour Doppler

P125: Study to evaluate the diagnostic accuracy of transvaginal ultrasound scanning in the detection of endometrial polyps

P125: Study to evaluate the diagnostic accuracy of transvaginal ultrasound scanning in the detection of endometrial polyps

Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps

The diagnostic accuracy of transvaginal ultrasonography and vaginal sonohysterography in detecting endometrial polyps in women suffering abnormal uterine bleeding are compared. One hundred and six patients suffering from menometrorrhagia were studied. To detect whether there was endometrial polyp or not, these patients were subjected to transvaginal ultrasonographic examination as well as to sonohysterography. The final diagnosis was established by diagnostic hysteroscopy and its guided biopsy. Transvaginal ultrasonography resulted in false positive and false negative rates of 25% and 36.2% respectively while the figures with sonohysterography were 5.4% and 8% respectively. Combining both techniques further improved such rates to 2.9% and 2.8% respectively but not significantly (p>0.1). The sensitivity and specificity were 64.5%, 75.5% for transvaginal ultrasonography, and 93.1%, 93.9% for sonohysterography (significantly higher: p<0.001). Sonohysterography is significantly more accurate than transvaginal ultrasonography in the detection of endometrial polyps in cases with abnormal uterine bleeding. Combining both techniques did not significantly improve the diagnostic accuracy. Sonohysterography is an accurate and cost effective method which requires a little skill.

Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps

Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps