Detection Of Uterine Cavity Abnormalities Research Articles

Diagnostic accuracy of saline infusion sonohysterography for evaluation of uterine cavity abnormalities in patients with abnormal uterine bleeding

Objectives: The objective of this study was to evaluate the diagnostic accuracy of saline infusion hysterosonography for detection of uterine cavity abnormalities using Hysteroscopy as the gold standard. Study Design: Analytical Quasi Experimental study. Setting: Obstetric and Gynaecology Department Madina Teaching Hospital Faisalabad. Period: July 2017 to December 2017. Materials and Methods: Sixty patients presented with abnormal uterine bleeding were included in the study. Transvaginal ultrasound, SIS and hysteroscopy performed for evaluation of the uterine cavity for any abnormality. Results: SIS helped in detection of intacavitary abnormalities in 39 out of 60 patients indicating sensitivity of 88. 64 % and specificity of 100 % as hysteroscopy confirm the findings in all the patients. The NPV is 76 % and PPV of 100 % taking hysteroscopy as gold standard. The diagnostic accuracy of saline infusion sonography is 91%. Conclusion: The addition of SIS to TVS significantly improved the sensitivity and specificity for detecting intracavitary pathology. It can be used as an alternative procedure whenever hysteroscopy is not available.

Comparing the Diagnostic Value of Hysterosalpingography with Hysteroscopy in Diagnosis of Uterine abnormalities in Infertile Women

Background & aim: Despite the identification of hysteroscopy as the most accurate method for the diagnosis of uterine cavity disorders, the patients are initially subjected to hysterosalpingography (HSG). In this regard, the present study aimed to compare the diagnostic value of HSG and hysteroscopy in the detection of uterine cavity abnormalities in infertile women. Methods: This cross-sectional study was conducted on 91 infertile women who needed to undergo hysteroscopy in the Gynecology Ward of Imam Reza Hospital in Mashhad, Iran, due to the detection of a uterine abnormality in their HSG or failure of intrauterine insemination and in vitro fertilization during 2013 to 2014. The results of HSG and hysteroscopy to detect uterine cavity changes were compared. Data analysis was performed in SPSS software (version 16) using McNemar’s test. P-value less than 0.05 was considered statistically significant. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of HSG were 38.78%, 78.57%, 67.86%, 52.38%, and 57.14%, respectively, in comparison to those of hysteroscopy. The results of the McNemar’s test revealed a significant difference between the results of HSG and hysteroscopy in the diagnosis of uterine cavity abnormalities (P=0.001). Conclusion: As the findings indicated, HSG had lower sensitivity, specificity, as well as positive and negative predictive values. Consequently, this method can be concluded as insufficient for the diagnosis of endometrial cavity disorders and incapable of diagnosing many factors affecting the outcome of infertility treatments. Therefore, all infertile women who are candidate for laparoscopy or those who need expensive infertility treatments are suggested to undergo hysteroscopy before the onset of treatment.

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.

Validity of Hysteroscopy in Detection of Uterine Cavity Abnormalities in Women with Recurrent Pregnancy Loss

Validity of Hysteroscopy in Detection of Uterine Cavity Abnormalities in Women with Recurrent Pregnancy Loss

To Evaluate the Accuracy of Saline Infusion Sonohysterography (SIS) for Evaluation of Uterine Cavity Abnormalities in Patients with Abnormal Uterine Bleeding.

To evaluate the accuracy of transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) for detection of uterine cavity abnormalities in patients with abnormal uterine bleeding (AUB) taking hysteroscopy as the gold standard. This was a prospective study done in the department of Obstetrics and Gynecology of a tertiary care academic hospital. Sixty premenopausal and postmenopausal women who presented with AUB underwent TVS, SIS, and hysteroscopy. The presence of focal abnormality and the type of abnormality, i.e., polyp, submucous myoma, and endometrial hyperplasia, were noted. The results of TVS and SIS were compared with hysteroscopy. On hysteroscopy, 76.67% (n=46) patients were diagnosed with intra cavity abnormalities. SIS showed sensitivity, specificity, PPV, and NPV of 89.1, 100, 100, and 73.7%, respectively. In comparison, TVS showed sensitivity, specificity, PPV, and NPV of 43.48, 78.57, 86.96, and 29.73%, respectively. SIS was found to be more sensitive and specific than TVS in detection of intra cavity abnormalities.

M029 THE ROLE OF 3-DIMENSIONAL SONOHYSTEROGRAPHY FOR DETECTION OF UTERINE CAVITY ABNORMALITIES AND PATHOLOGY OF THE FALLOPIAN TUBES IN PATIENTS WITH INFERTILITY

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S540-S540 Poster presentations M029 THE ROLE OF 3-DIMENSIONAL SONOHYSTEROGRAPHY FOR DETECTION OF UTERINE CAVITY ABNORMALITIES AND PATHOLOGY OF THE FALLOPIAN TUBES IN PATIENTS WITH INFERTILITY I. Esipova, I. EsipovaSearch for more papers by this authorI. Krasnova, I. KrasnovaSearch for more papers by this authorN. Kalmykova, N. KalmykovaSearch for more papers by this author I. Esipova, I. EsipovaSearch for more papers by this authorI. Krasnova, I. KrasnovaSearch for more papers by this authorN. Kalmykova, N. KalmykovaSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61223-5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S540-S540 RelatedInformation

Three-Dimensional Sonohysterography Compared With Vaginoscopic Hysteroscopy for Evaluation of the Uterine Cavity in Patients With Recurrent Implantation Failure in In Vitro Fertilization Cycles

Study ObjectiveTo estimate the degree of agreement between 3-dimensional sonohysterography (3D-SHG) and vaginoscopic hysteroscopy (VH) in detection of uterine cavity abnormalities in patients with recurrent implantation failure in in vitro fertilization cycles. DesignComparative observational cross-sectional study (Canadian Task Force classification II-1). SettingPrivate assisted-conception unit. PatientsOne hundred forty-three patients with a history of at least 2 previous implantation failures despite transfer of good quality embryos in assisted-conception cycles. Interventions3D-SHG was followed by VH. The Cohen κ for interrater agreement was calculated for the level of agreement between the 2 diagnostic procedures. Procedure time in seconds was recorded for both procedures. Patients were asked to rate their degree of discomfort or pain during both procedures using a visual analog scale. Measurements and Main ResultsThere was a substantial degree of concordance between 3D-SHG and VH (κ = 0.77; 95% confidence interval, 0.6–0.84). The median procedure time for 3D-SHG was 296 seconds (range, 231–327 seconds), and for VH was 315 seconds (range, 232–361 seconds), and the difference was statistically significant (p =.02). The visual analog scale pain scores also showed that 3D-SHG, with a median pain score of 2.1 (range, 1–3) was better tolerated than VH, with a median pain score of 2.9 (range, 2–4) (p < .001). ConclusionOur results show that there is a substantial degree of concordance between 3D-SHG and VH in diagnosing uterine cavity anomalies. We also found that 3D-SHG took significantly less time and induced less patient discomfort than did VH. We recommend that 3D-SHG should be the method of first choice for outpatient evaluation of the uterine cavity.

A comparative study of 2-dimensional sonohysterography versus 3-dimensional sonohysterography in infertile patients with uterine cavity lesions and abnormalities

Abstract Objective To compare 2-dimensional sonohysterography to 3-dimensional sonohysterography in detection of uterine cavity abnormalities in infertile patients. Design Prospective controlled study. Patients and methods Seventy seven infertile patients underwent the following transvaginal ultrasound techniques; 2D and 2D sonohysterography, 3D and 3D sonohysterography. Sensitivity, specificity, PPV, NPV, accuracy of 2D sonohysterography and 3D sonohysterography were calculated and compared to the gold standard of hysteroscopy laparoscopy. Results All 77 patients were studied using all four techniques. Both techniques of 2D and 3D sonohysterography were effective in reaching correct diagnosis. The overall sensitivity, specificity, PPV, NPV and accuracy of 2D sonohysterography was; 87.2, 100, 100, 84.2, 92.4, and 89.3 and that of 3D sonohysterography was; 100, 100, 86.4, and 93.6. The highest accuracy was obtained in diagnosis of endometrial polyps (98.7 and 100) and Mullerian anomalies (98.7 and 100) and the least with intrauterine synechiae (93.4 and 94.7). Conclusion 2D and 3D sonohysterography perform similarly in the diagnosis of uterine abnormalities as compared to hysteroscopy laparoscopy. If 3D technology is not available, 2D sonohysterography performs just as well.

Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy in postmenopausal bleeding

To compare the diagnostic accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) with respect to pathological diagnosis in the detection of uterine cavity abnormalities associated with abnormal uterine bleeding among postmenopausal women. Being a prospective, investigator-blind trial, the present study was conducted on 137 postmenopausal women, with abnormal uterine bleeding, admitted to the Department of Obstetrics and Gynecology of Istanbul Bilim University, Florence Nightingale Hospital and Fertigyn Woman Health and IVF Center. After TVS, all patients underwent SIS using Cook Soft 500 IVF transfer catheter and HS, consecutively. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated to compare the diagnostic accuracy of TVS, SIS and HS. Most commonly encountered endometrial lesions were polypoid lesion (38.0%) and hyperplasia (28.4%) among our study population consisting of 137 women (mean age 61.6 ± 9.6 years) in their postmenopausal stage. Overall sensitivity rates were 70.0% for TVS, 89.6% for SIS and 92.3% for HS, while the overall specificity rates were 50.0, 77.3 and 80.7%, respectively. HS had PPV of 96.2% and NPV of 65.3%, whereas PPV was determined to be 80.9 versus 95.3% and NPV was 35.4 versus 58.3% for TVS and SIS, respectively. As an easy to perform, safe and well-tolerated procedure yielding high diagnostic accuracy, saline infusion SIS via this catheter seems to be superior to TVS and very close to HS. It may be used as the primary method for the detection of uterine abnormalities among postmenopausal women with abnormal uterine bleeding.

Assessment of uterine factor in infertile women: Hysterosalpingography vs hysteroscopy

The objective of this study was to evaluate the diagnostic accuracy of hystero-salpingography (HSG) in detecting uterine cavity abnormalities in infertile patients, with reference to hysteroscopy as the gold standard method. 60 infertile women were investigated with both HSG and hysteroscopy. Statistical analysis was performed. As a test for the detection of uterine cavity abnormalities, HSG in comparison with hysteroscopy had 60% sensitivity, 90% specificity, 10% false positive value and 40% false negative value. HSG is not able to diagnose polyps, septum and submucous fibroids with significant accuracy. Therefore hysteroscopy is indicated for confirmation.

Uterine cavity assessment in infertile women: comparison of transvaginal sonography and hysteroscopy

Objectives: To evaluate the diagnostic accuracy of transvaginal sonography (TVS) in detecting uterine cavity abnormalities in infertile patients, with reference to hysteroscopy as the gold standard method. Study Design: At the Institute of Obstetrics and Gynaecology, University of Bari, 134 infertile women were investigated with both TVS and hysteroscopy. In all cases endometrial biopsy was performed. Sensitivity, specificity, and positive and negative predictive values were calculated for TVS, considering hysteroscopic diagnosis as the gold standard. Statistical analysis was performed by using McNemar test. Results: There was one failed insertion of hysteroscope. Hysteroscopy diagnosed pathological findings in 58 out of 133 cases (44%). TVS was in agreement with 50 of the 58 (86%) of the pathological findings diagnosed at hysteroscopy. As a test for the detection of uterine cavity abnormalities, TVS in comparison with hysteroscopy had 84.5% sensitivity and 98.7% specificity, 98.0% positive predictive value and 89.2% negative predictive value. Conclusions: TVS is able to diagnose polyps, septum and submucous fibroids with quite significant accuracy, while hysteroscopy is indicated for their confirmation and removal. Thus, hysteroscopy provides both diagnostic and therapeutic capabilities, but TVS permits to proceed directly to operative hysteroscopy avoiding the need for a separate diagnostic procedure.

Sonohysterography (SHG) is more sensitive than hysterosalpingography (HSG) in the detection of intracavitary abnormalities.

Objective: To determine the sensitivity, specificity, predictive value of a positive and a negative test, of transvaginal (TV) ultrasonongraphy (U/S), sonohysterography (SHG), and HSG in the detection of uterine cavity abnormalities. Design: Volunteers were recruited from patients undergoing routine hysteroscopy as part of their evaluation for infertility. An SHG was performed in the OR just prior to the hysteroscopy. These data were retrospectively compared to findings on outpatient HSG. The clinician performing the SHG was blinded to findings on preoperative HSG. The hysteroscopies were performed within two months of HSG. The results of both the HSG and SHG were compared to hysteroscopic findings. Materials/Methods: Intraoperative SHG was performed with an ULTRAMARK 4 [copy](ATL) US machine affixed with a 5.0/7.5 MHz transducer. Measurements of the uterine and ovarian size, bilayer endometrial stripe thickness, and the presence of abnormalities were recorded. An SHG was then performed with a 5.0F H/S catheter© (Ackrad Lab Inc., Cranford, N.J.) and 10-20 cc’s of sterile saline. The uterus was systematically visualized in saggital and coronal planes. If present any polyps, submucosal myomas, or other abnormalities were measured, and their locations within the uterus and cavity noted. Preoperative HSG’s were performed under fluoroscopic guidance with a standard cone insufflation device and 10-20 cc of sinograffin. All hysteroscopies were performed in the operating room with standard distension media. Results: Although these data are limited by small sample size, sonohysterography appears to be the most specific test for the detection of uterine cavity abnormalities. See table. Results comparing TV U/S, HSG, and SHG to findings at the time of hysteroscopy. Tabled 1TV U/S (%)HSG (%)SHG (%)Sensitivity57100100Specificity8667100PV (+)10078100PV (−)67100100 Open table in a new tab Conclusions: Sonohysterography is likely to be more sensitive and specific than routine transvaginal ultrasound and HSG in the detection of uterine cavity abnormalities. These data suggest sonohysterography should be considered the procedure of choice prior to ovulation induction and ART. Supported By: ACOG/Tambrands Grant for Menstrual Health.