Diagnostic Accuracy Of Transvaginal Sonography Research Articles

SALINE INFUSION SONOGRAPHY: A VALID TOOL FOR DETECTION OF INTRAUTERINE PATHOLOGY IN WOMEN WITH ABNORMAL UTERINE BLEEDING

ABSTRACT:
 OBJECTIVE:
 To evaluate the diagnostic accuracy of transvaginal ultrasound and saline infusion sonography for the detection of intra-cavity lesions of uterus using histopathology on hysterectomy specimens as the gold standard.
 STUDY DESIGN:
 Cross-sectional (validation) study.
 Place & duration of study:
 Department of obstetrics & gynecology, Madina Teaching Hospital, Faisalabad from January 18, 2022 to September 30, 2022.
 METHODOLOGY:
 Sixty patients with abnormal uterine bleeding and postmenopausal bleeding were included in the study. All participants were evaluated by transvaginal ultrasound (TVS) and saline infusion sonography (SIS) to detect uterine cavity pathologies. The findings at TVS and SIS were compared with the findings of histopathology on hysterectomy specimens. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated.
 RESULTS:
 Mean age was 49.68±5.9 years. Polyps, proliferative endometrium, endometrial hyperplasia and sub mucous fibroid are noted in 32 (53.3%), 16 (26.7%), 3 (5%) and 9 (15%) patients, Sensitivity, specificity, PPV, NPV and diagnostic accuracy of TVS are 61.36%, 100%, 100%, 48.48% and 71.67% and for SIS are 88.64%, 100%, 100%, 76.19% and 91.67% respectively.
 CONCLUSION:
 SIS is highly sensitive and specific investigation to detect intra-cavity abnormalities of uterus. SIS can be used as an alternative investigation tool in low resource settings whenever hysteroscopy in not readily available.
 KEY WORDS: Uterine cavity lesions, sensitivity, specificity, saline infusion sonography
 

Diagnostic Accuracy of Transvaginal Ultrasound in the Evaluation of Female Infertility: A Systematic Review

Female infertility can result from issues with the fallopian tubes, uterus, and cervix. Ultrasound has become an essential component of the modern investigation of female infertility and the management of assisted conception, which is able to access endometrial and uterine factors that affect embryo implantation. To date, Transvaginal ultrasound (TVS) has become the modality of choice for the initial study of female infertility since it is widely available, cost-effective, and non-invasive. This study aims to assess the diagnostic accuracy of TVS in evaluating female infertility and how different types of abnormalities in female infertility affect the diagnostic accuracy. The systematic search in this study followed the guidelines of the Preferred Reporting Items for Systematic Reviews (PRISMA) and Meta-Analyses. The electronic databases PubMed and ScienceDirect were utilized. Papers published between 2012 and 2022 were chosen and subjected to analysis following the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). In the initial search strategy, a total of 217 articles were discovered. By applying specific criteria for inclusion and exclusion, a set of five studies involving 770 patients were chosen for analysis. Forest plot analysis of these five studies evaluating sensitivity and specificity demonstrated low heterogeneity (Q = 4.574) and moderate heterogeneity (Q = 20.771) respectively. Employing a random-effects model, transvaginal ultrasound (TVS) demonstrated a favorable overall accuracy for evaluating female infertility with a pooled sensitivity of 0.79 (95% CI: 0.60, 0.99), and a specificity of 0.96 (95% CI: 0.76, 1.17). The sensitivity and specificity may vary depending on the specific abnormality being assessed. The most observed abnormalities were endometrial polyps and uterine fibroids, while uterine cancer and adenomyosis were the least frequently observed abnormalities. Findings from this study suggest that TVS offers moderate accuracy in the evaluation of female infertility. TVS is particularly valuable when used in conjunction with hysteroscopy, as it demonstrates high accuracy in detecting and characterizing abnormalities.

The Diagnostic Accuracy of Transvaginal Ultrasound for Detection of Ureteral Involvement in Deep Infiltrating Endometriosis: A Systematic Review and Meta-Analysis.

The aim of this study is to determine the accuracy of transvaginal ultrasound (TVU) for the diagnosis of ureteral involvement in women with deep infiltrating endometriosis (DIE). The meta-analysis included primary studies comparing the use of TVU for diagnosing endometriotic involvement of the ureter, using laparoscopic surgery and histological diagnosis as the reference standard. Search was performed in several databases (Scopus, Web of Science, and PubMed/MEDLINE). The studies' quality and bias risk were assessed using the Quality Assessment of Diagnostic Accuracy Study-2 (QUADAS-2). Diagnostic performance was estimated by assessing pooled sensitivity and specificity. A total of 496 citations were found. Six articles were ultimately selected for this systematic review and meta-analysis after the inclusion and exclusion criteria were applied. Pooled sensitivity and specificity were 0.81 (95% CI: 0.42-0.96), 1.00 (95% CI: 0.93-1.00). The heterogeneity observed was high for both sensitivity and specificity. Overall risk of bias was low. TVU is a valuable tool for the pre-operative identification of ureteral involvement by DIE.

Diagnostic Accuracy of Transvaginal Ultrasound in Adenomyosis Taking MRI as a Gold Standard.

To evaluate the accuracy of transvaginal ultrasound in the diagnosis of adenomyosis using MRI as the gold standard, and to characterise the most commonly seen and accurate ultrasonographic features and their combination. Cross-sectional, descriptive study. Place and Duration of the Study: Department of Radiology, The Aga Khan University Hospital, Karachi, from January 2018 to July 2021. Transvaginal ultrasound examination was performed on patients (n = 208) who presented with symptoms related to menstrual cycles and pelvic abnormalities. Additionally, patients who sought infertility evaluation were also included in the study. The findings from the ultrasound examinations were assessed and tabulated alongside the results of the MRI scans. All examinations were conducted by senior radiologists / sonographers. The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of ultrasound features were calculated individually and in combination, taking MRI as the gold standard. To enhance the accuracy of ultrasound findings, various variables were combined, and their sensitivities and specificities were calculated. Overall, transvaginal ultrasound had a high specificity of 96.15% (95% CI: 85.67 - 99.33), a relatively low sensitivity of 74.36% (95% CI: 66.63 - 80.85), PPV of 98.31 (95% CI: 93.40 - 99.70) and NPV of 55.56 (95% CI: 44.73 - 65.90). The most sensitive dual variable used was a bulky uterus combined with altered myometrial echotexture, with a sensitivity of 72.97% (95% CI: 64.95 - 79.78) and specificity of 95.83% (95% CI: 84.57-99.27). The best combined triple variable was a bulky uterus with altered echotexture and streaky myometrium, with a sensitivity of 71.85% (95% CI: 63.35 - 79.10) and a specificity of 95.46% (95% CI: 83.30 - 99.21). Transvaginal ultrasound features can identify adenomyosis characteristics in most of the patients. This could reduce the number of pelvic MRIs performed for the detection of adenomyosis. Adenomyosis, Diagnosis, Magnetic resonance imaging, Bulky uterus, Altered myometrial, Echotexture, Ultrasound.

Comparison of the application value of transvaginal ultrasound and transabdominal ultrasound in the diagnosis of ectopic pregnancy.

Ectopic pregnancy (EP) is one of the most common acute abdominal diseases in gynecology. Once the condition of EP is delayed, it may lead to massive hemorrhage, shock, and even death in a short time, seriously threatening the patient's life. Early diagnosis is the key to preventing and improving the prognosis of EP. Transabdominal ultrasound (TAS) and transvaginal ultrasound (TVS) are the main diagnostic methods for abdominal diseases. The purpose of this study is to explore the application value and effect of TAS and TVS in the diagnosis of EP, hoping to provide more valuable references for the diagnosis of EP. To explore the application value of TAS and TVS in the diagnosis of EP and to improve the level of clinical diagnosis. A total of 140 patients with EP admitted to our hospital from July 2018 to July 2020 were selected for this study. All patients were divided into two groups according to the examination methods. 63 patients who underwent abdominal ultrasound examination were set as the TAS group, while 77 patients who underwent TVS examination were set as the TVS group. We compared the diagnostic accuracy and misdiagnosis rates between the two types of ultrasound examinations, as well as the postoperative pathological results of the two diagnostic methods for different types of ectopic pregnancies. We also analyzed the sonograms for the presence of mixed ectopic masses, adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the ectopic sac shadow, and the detection of fluid in the rectal fossa of the uterus, such as the adnexal area, yolk sac, and embryo, etc. In addition, the diagnosis time, days of gestational sac appearance, operation time, endometrial thickness, and blood flow resistance index were compared as well. After performing both types of ultrasound examinations in 140 patients with EP, we found that the diagnostic accuracy of TVS was significantly higher than that of TAS, and the misdiagnosis rate was significantly lower than that of TAS. The differences were statistically significant (P < 0.05). In addition, the detection rate of TVS was better than that of TAS for the presence of mixed masses, adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the shadow of the ectopic sac, and sonograms such as the adnexal area, yolk sac, and embryo, etc. The coincidence rate of its postoperative pathological examination results was significantly higher than those of TAS. The diagnosis time and the days of gestational sac appearance by TVS were significantly shorter than that by TAS, and the operation time was earlier than that by TAS. What's more, the detection rates of the endometrial thickness £ 1.5 mm and blood flow resistance £ 0.5 were significantly higher in TVS diagnosis of EP than in TAS. All differences were statistically significant (P < 0.05). Compared with TAS, TVS has the advantages of high detection accuracy and good sonogram performance.

Diagnostic Accuracy of Transvaginal Sonography in Adenomyosis Taking Histo- pathology as Gold Standard in Infertile Women

Objective: To assess the accuracy of transvaginal sonography in the detection of adenomyosis, with histopathological examination serving as the gold standard, among a population of women struggling with infertility. Material and Methods: In this study, a group of 193 women with infertility &amp; suspected adenomyosis was included. Each subject was examined using transvaginal ultrasound, followed by surgical interventions such as dilatation and curettage, accompanied by detailed follow-up assessments. The effectiveness of transvaginal sonography in identifying adenomyosis was evaluated by comparing it to the histopathological diagnosis. Results: Histopathological analysis confirmed adenomyosis in 162 (83.9%) of the 193 patients, whereas transvaginal sonography identified 151 (78.2%). The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of transvaginal sonography in diagnosing adenomyosis were calculated to be 90.74%, 87.10%, 97.35%, 64.29%, and 90.16%, respectively. Conclusion: Transvaginal sonography demonstrates considerable sensitivity and specificity in diagnosing adenomyosis, obviating the necessity for supplementary diagnostic investigations.

Diagnostic Accuracy of Transvaginal Sonography for Deeply Infiltrating Endometriosis and Pouch of Douglas Obliteration in the Presence or Absence of Ovarian Endometrioma

Background: Endometriosis is one of the most common gynecological diseases worldwide. Significant attention has been drawn to this multiorgan and often painful disorder. Objectives: This study aimed to examine the accuracy of transvaginal sonography (TVS) in the diagnosis of deeply infiltrating endometriosis (DIE) with respect to the presence or absence of ovarian endometrioma (OE). Patients and Methods: This cross-sectional study was performed on all patients undergoing TVS before gynecological laparoscopy. With pathological confirmation as the standard reference, the diagnostic accuracy of TVS for DIE and pouch of Douglas (POD) obliteration was compared with that of laparoscopy in the anterior and posterior pelvic compartments with respect to the presence or absence of OE. Agreement between TVS and laparoscopy was evaluated for each case, and Cohen’s kappa statistic was measured for each site of involvement. Moreover, sensitivity, specificity, negative and positive predictive values, and likelihood ratios of TVS were calculated, with laparoscopy as the reference test. Results: A total of 110 patients, with a mean age of 37.20 ± 7.16 years, were recruited in this study. The accuracy, sensitivity, and negative predictive value of TVS for the diagnosis of DIE and POD obliteration were estimated at 89.5%, 58.3%, and 88.9% in the anterior pelvic compartment and 93.3%, 92%, and 70.6% in the posterior pelvic compartment, respectively. Nevertheless, TVS showed lower sensitivity for detecting pelvic adhesions and peritoneal cysts compared to laparoscopy. The presence of OE did not significantly increase the accuracy of TVS for the diagnosis of DIE or POD obliteration (P &gt; 0.05). Conclusion: The present study showed that TVS is an adequately accurate and non-invasive diagnostic tool for the detection and mapping of DIE and POD obliteration, regardless of the presence of OE. TVS may waive the need for exploratory laparoscopy in DIE or at least facilitate precise pre-procedural DIE mapping.

Diagnostic accuracy of transvaginal sonography for detecting parametrial involvement in women with deep endometriosis: systematic review and meta-analysis.

ABSTRACTObjectiveTo evaluate the accuracy of transvaginal sonography (TVS) for detecting parametrial deep endometriosis, using laparoscopy as the reference standard.MethodsA search was performed in PubMed/MEDLINE and Web of Science for studies evaluating TVS for detecting parametrial involvement in women with suspected deep endometriosis, as compared with laparoscopy, from January 2000 to December 2020. The Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity and positive and negative likelihood ratios for TVS in the detection of parametrial deep endometriosis were calculated, and the post‐test probability of parametrial deep endometriosis following a positive or negative test was determined.ResultsThe search identified 134 citations. Four studies, comprising 560 patients, were included in the analysis. The mean prevalence of parametrial deep endometriosis at surgery was 18%. Overall, the pooled estimated sensitivity, specificity and positive and negative likelihood ratios of TVS in the detection of parametrial deep endometriosis were 31% (95% CI, 10–64%), 98% (95% CI, 95–99%), 18.5 (95% CI, 8.8–38.9) and 0.70 (95% CI, 0.46–1.06), respectively. The diagnostic odds ratio was 26 (95% CI, 10–68). Heterogeneity was high. Visualization of a lesion suspected to be parametrial deep endometriosis on TVS increased significantly the post‐test probability of parametrial deep endometriosis.ConclusionTVS has high specificity but low sensitivity for the detection of parametrial deep endometriosis. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Validity of Hysteroscopy and Transvaginal Sonography in Evaluating Abnormal Uterine Bleeding- A Retrospective Study

Introduction: Abnormal Uterine Bleeding (AUB) affects 14-25% of women of reproductive age group and accounts for 66% of hysterectomies. Accurate diagnosis of the cause of AUB will reduce the hysterectomy burden, but the ideal evaluating tool to accurately diagnose the cause of the same is debatable. Aim: To evaluate the diagnostic accuracy of transvaginal sonography and hysteroscopy in the evaluation of abnormal uterine bleeding, using histopathological diagnosis as gold standard. Materials and Methods: This retrospective descriptive study was conducted on patients who underwent transvaginal sonography and hysteroscopy for evaluation of abnormal uterine bleeding from January 2017 to January 2020. Data including demographic details, sonographic details, pre-operative diagnosis, anaesthesia used, operative notes, complications and histopathological diagnosis were obtained from clinical record sheet of the patients. Sensitivity, specificity, diagnostic accuracy of TVS and hysteroscopy was calculated using MedCalc software version 19.2.6. Results: A total of 214 patients were enrolled in the study. Hysteroscopy reported &gt;95% diagnostic accuracy for all intrauterine pathology compared to TVS which revealed diagnostic accuracy of 73.13% for polyp, 77.1% for endometrial hyperplasia and 73.6% for all other pathology. Hysteroscopy revealed strong to almost perfect correlation with histopathological diagnosis for all pathology compared to TVS which demonstrated weak correlation for various intrauterine pathology. Conclusion: Hysteroscopy should be used as initial evaluating tool in AUB as it is simple and minimal-invasive with high diagnostic accuracy.

VP63.17: A retrospective study on the diagnostic accuracy of transvaginal sonography of adenomyosis in a single tertiary hospital

To be able to evaluate the diagnostic performance of transvaginal sonography in the diagnosis of adenomyosis from March 2017 to September 2019. A two-year retrospective study who had transvaginal ultrasound diagnosis of adenomyosis and underwent hysterectomy and histopathologic confirmation of adenomyosis. Frequency and proportion were used for nominal variables, median and range for ordinal variables, and mean and standard deviation for interval/ratio variables. Sensitivity, specificity, predictive value, and likelihood ratio of the transvaginal sonography in detecting adenomyosis was performed; 95% CI intervals were reported. 242 women were included, mean age was 45.69 ± 5.76 years and 54% had adenomyosis by transvaginal ultrasound. Institutional use of TVS demonstrated low to moderate sensitivity (67.1%), specificity (70.2%) and overall accuracy (68.18%) in diagnosing adenomyosis. The PPV was good at 80.9% but the NPV was relatively low at 53.2%. The positive and negative likelihood ratios predict approximately 15% increase and 15% decrease in pre-test probabilities of disease, respectively. Patients who had adenomyosis on histopathology, 67.1% probability that TVS will turn positive for adenomyosis (sensitivity). Patients without adenomyosis on histopathology, we have 70.2% probability that TVS will be negative for adenomyosis (specificity). Patients who had adenomyosis on histopathology are 2.25 times more likely to yield a positive result on TVS and 0.47 times less likely to yield a negative result on TVS for adenomyosis (LR-). When TVS is positive for adenomyosis, we have 80.9% probability that the patient has adenomyosis on histopathology (PPV). When TVS is negative for adenomyosis, we have 53.2% probability that the patient doesn't have adenomyosis on histopathology (NPV). Overall, the accuracy of TVS in detecting adenomyosis is 68.18%, using histopathology as a reference standard.

The comparison of saline infusion sonography and transvaginal sonography for the intracavitary lesions in infertile women

Aim: The aim of this study is to compare the diagnostic accuracy of transvaginal sonography and saline infusion sonography in the detection of intracavitary space-occupying lesions (endometrial polyp and submucous fibroid) in infertile women.Material and Methods: Three hundred and twenty-three women with infertility were involved in this retrospective study. The diagnostic accuracy of transvaginal sonography and saline infusion sonography were compared with respect to evaluation by diagnostic hysteroscopy results. The sensitivity, specificity, predictive values and ROC curves were used to determine the efficacy of methods for detecting the intracavitary space-occupying lesions in infertile patients.Results: The incidence of intracavitary space-occupying lesions was 82.1% infertile women. The endometrial polyp and submucous fibroid were established in 56 (17.3%) and 5(1.5%) patients, respectively. The sensitivity and specificity of transvaginal sonography were 50.8% and 98.1%, respectively. These values were 80.3% and 98.5% for saline infusion sonography, respectively. Saline infusion sonography was found superior to transvaginal sonography for evaluating the intracavitary space-occupying lesions.Conclusion: Saline infusion sonography was more accurate diagnostic modality than transvaginal sonography to assess the intracavitary space-occupying lesions in the infertility population. Therefore the addition of saline infusion sonography to the infertility workup may prevent unnecessary invasive procedures to evaluate the uterine cavity.

Comparative Study of the Diagnostic Accuracy of Transvaginal Sonography vs Hysteroscopy in Abnormal Uterine Bleeding

Comparative Study of the Diagnostic Accuracy of Transvaginal Sonography vs Hysteroscopy in Abnormal Uterine Bleeding

Can Enhanced Techniques Improve the Diagnostic Accuracy of Transvaginal Sonography and Magnetic Resonance Imaging for Rectosigmoid Endometriosis? A Systematic Review and Meta-analysis.

Our aim was to perform a systematic review and meta-analysis of the most commonly used examinations for rectosigmoid lesions of deeply infiltrating endometriosis, transvaginal sonography (TVS) and magnetic resonance imaging (MRI), to compare their diagnostic accuracy and enhanced or non-enhanced techniques. A systematic search was performed until March 2018 without time or language restrictions. Eligibility criteria included studies that compared the accuracy of TVS and MRI for diagnosis of rectosigmoid endometriosis. The quality of the studies was assessed by means of Quality Assessment of Diagnostic Accuracy Studies-2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Bivariate and hierarchical analysis were performed. The difference in the accuracy of TVS and MRI was tested, and heterogeneity was addressed by means of meta-regression, sensitivity, or subgroup analysis. A total of 1754 studies were screened; 105 studies were eligible, and 11 studies were included in the meta-analysis. Overall pooled sensitivity, specificity, and area under the receiver operating characteristic curve were 0.80, 0.94, and 0.95, respectively. The measures for MRI were 0.82, 0.94, and 0.95, respectively. There was no statistical difference between the accuracy values of TVS and MRI (P = 0.90). The use of bowel preparation and vaginal contrast could enhance the accuracy of MRI. Along with rectosigmoid prevalence, bowel and vaginal contrast explained a significant proportion of the statistical heterogeneity. Both TVS and MRI showed high diagnostic accuracy for rectosigmoid deeply infiltrating endometriosis lesions. There is no strong evidence suggesting that the two diagnostic methods might differ in specificity or sensitivity, but enhanced techniques may increase the accuracy measures.

Comparison of Diagnostic Accuracy of Transvaginal Ultrasound for Deep Endometriosis and Pouch of Douglas Obliteration in The Presence and Absence of Ovarian Endometriomas

Study Objective We aim to evaluate and compare the diagnostic accuracy of deep endometriosis transvaginal ultrasound (DE TVS) in the presence and absence of ovarian endometriomas (OEs). Design This is a multicenter observational study of prospectively collected data. Setting Patients attended one of two gynecology-focused ultrasound practices and underwent laparoscopy at one of nine hospitals in the Sydney metropolitan area between 2009 and 2017. Patients or Participants Patients referred with suspected endometriosis. Interventions A DE TVS was performed in all patients and reported in a systematic fashion. Measurements and Main Results Surgical findings were the defined reference standard. Data were analyzed to determine the prevalence of surgically-diagnosed DE and pouch of Douglas (POD) obliteration in the presence or absence of OEs. DE TVS was assessed in terms of accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive (LR+) and negative (LR-) likelihood ratios. Comparison of DE TVS prediction of DE and POD obliteration in patients with versus those without OEs was performed. 410 patients were included. An OE was noted in 91, 22.2% patients (left: 66, 16.3%; right: 58, 14.2%; bilateral: 33, 8.2%). When comparing those with and without an OE, DE prevalence was 62/91, 68.1% and 81/313, 25.9%, respectively, and POD obliteration prevalence was 55/91, 60.4% and 31/313, 9.9%, respectively (p Conclusion The prevalence of DE and POD obliteration in patients without OEs is lower, but not negligible. Diagnostic accuracy of DE TVS is poorer in patients without OEs, which is not well understood and concerning as many patients may be falsely reassured.

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.

Uterine alterations in women undergoing routine hysteroscopy before in vitro fertilization: high prevalence of unsuspected lesions

Objective:The aim of this study was to verify the prevalence of uterine cavity abnormalities diagnosed by routine office hysteroscopy in women preparing to IVF.Methods:We carried out a retrospective cross-sectional study of 1141 consecutive women who underwent outpatient hysteroscopy before IVF at a tertiary academic center. Of these, 961 participants had a normal transvaginal sonography (TVS) of the uterine cavity. The prevalence of hysteroscopic alterations in successive age strata was submitted to Mantel-Haenzsel Chi-square test for linear trend. The diagnostic accuracy of TVS using hysteroscopy as reference was assessed by calculating the sensitivity, specificity, positive and negative likelihood ratios.Results:Hysteroscopic alterations were present in 265/961 of patients with a negative TVS (prevalence 27.6%, 95% confidence interval [CI] 24.8%-30.5%). The prevalence of unsuspected submucous leiomyoma was higher among older women (p=0.005, chi-square test for linear trend) and reached 7.2% (95% CI 3.5%-14.1%) after 40 years. The sensitivity of TVS ranged from 8% (95% CI 2%-20%) for uterine synechiae to 41% (95% CI 28%-56%) for submucous leiomyoma, resulting in low likelihood ratios for negative TVS results.Conclusions:These findings suggest a high prevalence of unsuspected alterations found by routine hysteroscopy before IVF, an age-dependent increase in the frequency of submucous leiomyoma and a low diagnostic sensitivity of TVS to detect intracavitary lesions.

Concomitant Saline Infused Sonohysterography and Endometrial Sampling of Intrauterine Pathology Using SonoSure Device

Saline Infusion Sonohysterography (SIS) has become a routine diagnostic tool for the female reproductive tract and provides better visualization and detection of intrauterine pathology, enhancing the diagnostic accuracy of Transvaginal Ultrasound (TVS) in women with Abnormal Uterine Bleeding (AUB). While saline infusion sonohysterography and Endometrial Biopsy (EMB) are routinely used in the workup for AUB, few providers perform these procedures concurrently.

Diagnostic Accuracy of Transvaginal Sonography for Abnormal Uterine Bleeding [31G

INTRODUCTION: The prevalence of intrauterine abnormalities in patients with abnormal uterine bleeding is 46%. Historical data gives the transvaginal sonography (TVS) a sensitivity and specificity of 56% and 73% for detecting intracavitary pathology respectively, however the image resolution of the ultrasound machines has improved significantly since those studies. The objective of this study is to calculate the sensitivity, specificity, positive and negative predictive values of TVS. METHODS: Retrospective chart review of patients who had a TVS and a subsequent hysteroscopy performed in the operating room at The Western Pennsylvania Hospital. 500 patients were needed for a 95% Confidence Interval of 0.06% RESULTS: Between January 2013 and September 2015, 2351 hysteroscopies were performed. Using a randomization software, 500 randomly selected patients that met inclusion criteria underwent chart review. The hysteroscopic findings were: normal cavity (243), endometrial polyp (157), atrophic endometrium (34), submucosal fibroid (25), other (41). We found a sensitivity of 63%, specificity 80.9%, positive and negative predictive values 67.9% and 77.4% respectively, a significant improvement comparing to historical data, however far from the most accurate studies, the sonohysterogram and diagnostic hysteroscopy. CONCLUSION: A false positive rate of 11% is still high if the next step in management will be a hysteroscopy performed in the operating room. In the last 2 years 258 hysteroscopies were performed in the operating room with a false positive diagnosis of intracavitary lesion. This results support the current recommendations of performing a sonohysterogram or office hysteroscopy after a TVS finding of intracavitary pathology.

Diagnostic Accuracy of Transvaginal Ultrasound in Perimenopausal and Postmenopausal Bleeding

Diagnostic Accuracy of Transvaginal Ultrasound in Perimenopausal and Postmenopausal Bleeding

Prediction of endometriosis by transvaginal ultrasound in reproductive-age women with normal ovarian size

To predict endometriosis by transvaginal ultrasound (TVS) in reproductive-age women with normal ovarian size. Prospective study. El-Shatby Maternity Hospital, Alexandria University. 125 Women with symptoms suggestive of endometriosis and with normal ovarian size during TVS. Patients were subjected to high frequency ultrasound and evaluated for the presence of ultrasound signs of endometriosis (TVS-based soft markers). All patients had laparoscopy (gold standard) immediately after TVS for documentation of the presence of endometriosis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of TVS and of the TVS-based soft markers in diagnosing endometriosis. Endometriosis was confirmed laparoscopicaly in 68/125 patients (54.4%). The sensitivity, specificity, PPV, NPV and diagnostic accuracy of TVS in diagnosing endometriosis were 85.3%, 80.7%, 84.1%, 82.1% and 83.2%, respectively. Six TVS-based soft markers showed significant association ( P < 0.05) with endometriosis (ovaries not at the same level, high left ovary, ovarian fixation to uterus, tender ultrasound, ovarian fixation to iliac vessels and non visualization of left ovary) with sensitivities of 85.3%, 80.9%, 80.9%, 66.2%, 55.9% and 55.9%, respectively. These markers could be considered as positive soft markers to predict endometriosis. The addition of these soft markers could improve the sensitivity, specificity, PPV, NPV and diagnostic accuracy to 97.3%, 98.5%, 95.7%, 89.9% and 91.2%, respectively. TVS appears to be a useful imaging method for the prediction of endometriosis. The inclusion of TVS-based positive soft markers either alone or in combination improves our ability to predict endometriosis.