Diagnostic Accuracy Of Transvaginal Sonography Research Articles

Ultrasound in the Diagnosis of Endometriosis

Background: To evaluate diagnostic accuracy of transvaginal sonography and laparoscopy in the diagnosis of endometriosis. Patients and Methods: This was a prospective study of women scheduled for laparoscopy because of infertility assessment. Consecutive patients were assessed prospectively using TVS before laparoscopy and the findings of preoperative TVS were compared with the results obtained by laparoscopy as a gold standard. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were calculated for the diagnosis of endometriosis. Results: In total, 262 women (mean age 31 + 4.47) had preoperative TVS and laparoscopies. Of these, 78 had endometriosis. Diagnostic accuracy was assessed; the sensitivity and specificity of the TVS in the diagnosis of pelvic endometriosis were 53% and 95%, respectively, and the positive and negative predictive value were 63% and 92%, respectively. The diagnostic accuracy was 88%. Conclusions: TVS is a good test for assessing pelvic endometriosis. Good specificity and sensitivity were obtained in the diagnosis of deep endometriosis. TVS is particularly accurate in detecting deep endometriosis, which could facilitate more effective triaging of women for appropriate surgical care.

DIAGNOSTIC ACCURACY OF TRANSVAGINAL ULTRASOUND IN CLINICALLY SUSPECTED CASES OF RETAINED PRODUCTS OF CONCEPTION

Aim: The aim of this study was to determine the diagnostic accuracy of transvaginal ultrasound (TVUS) in clinically suspected cases of retained products of conception taking histopathology findings as gold standard. The author had already reported the sensitivity for the detection of RPOC using conventional medium frequency (3.5 MHz) probe through transabdominal approach and has tried to assess the improvement in the sensitivity using trans vaginal sonographic approach. This study was not designed to compare efficacy of transabdominal with Trans vaginal sonography for the detection of retained products of conception for which another research project is underway in the same department results of which will be published in due course of time.
 Material and Methods: The study was conducted in the Department of Diagnostic Radiology, Lahore General Hospital, Lahore. All patients included in the study were within the age bracket of 15-45 years who attended Emergency and/or Outpatient Department (OPD) from June 2009 to May 2013 and were referred by Gynaecology Department on the suspicion of having Retained Products of Conception (RPOC) on the basis of history and/or clinical examination. Detailed relevant history and physical examination findings were recorded in all the cases. Transvaginal ultrasound with a 7.5 MHz convex array transducer was performed in each of the referred cases. The cases underwent histopathology of the extracted material. The results of transvaginal ultrasound and histopathology were compared taking histopathologic findings as gold standard.
 Results: A total of 160 patients with clinical suspicion of Retained Products of Conception were registered during this period. The highest number of patients, i.e 68 (42.5%) were aged between 26-35 years. Out of 160 patients, 85 patients (53.12%) had RPOC on TVUS. After comparison of results of Transvaginal ultrasound with histopathology, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of TVUS were 97.6%, 96.05%, 96.4%, 97.3% and 96.8% respectively.
 Conclusion: We recommend TVUS for the evaluation of retained products of conception because it is a highly accurate and convenient imaging modality and can play a significant role in decreasing unnecessary surgical intervention and exploration of uterine cavity hence reducing the attendant possible complications (endometritis, adhesion formation, infertility etc), planning management and estimating patient’s prognosis.

A comparison between ultrasonography and hysteroscopy in the diagnosis of uterine pathology

ObjectiveTo evaluate the diagnostic accuracy of transvaginal sonography (TVS) compared to hysteroscopy in diagnosing uterine abnormalities. In addition, to determine whether the number of diagnostic hysteroscopies can be reduced and replaced by TVS examinations. Study designIn this retrospective study, we summarized data from 128 patients who underwent TVS examination and hysteroscopy in our ultrasound unit during the last two years. Specimens were obtained and sent for histopathological examination. Sensitivity, specificity, positive and negative predictive values for diagnosing uterine pathology were calculated for each method. ResultsHysteroscopy had a significantly higher sensitivity in diagnosing intra-uterine fibroids while TVS had a significantly higher sensitivity in diagnosing retained products of conception. Although hysteroscopy had better predictive values for diagnosing uterine polyps the difference was not statistically significant. The combination of both TVS and hysteroscopy did not seem to improve the sensitivity and specificity. There were three additional important findings: two cases of uterine hyperplasia and one case of endometrial carcinoma in patients with abnormal uterine bleeding were all diagnosed by hysteroscopy after being suspected on the TVS examination. ConclusionTVS is an excellent tool in evaluating retained products of conception. In other cases of uterine pathology, diagnostic hysteroscopy is needed to improve diagnostic accuracy.

Diagnostic Accuracy of Transvaginal Sonography in the Detection of Uterine Abnormalities in Infertile Women

BackgroundAccurate diagnosis of uterine abnormalities has become a core part of the fertility work-up. A variety of modalities can be used for the diagnosis of uterine abnormalities.ObjectivesThis study was designed to assess the diagnostic accuracy of transvaginal ultrasonography (TVS) in uterine pathologies of infertile patients using hysteroscopy as the gold standard.Patients and MethodsThis was a cross-sectional study carried out in the Department of Reproductive Imaging at Royan Institute from October 2007 to October 2008. In this study, the medical documents of 719 infertile women who were investigated with transvaginal ultrasound (TVS) and then hysteroscopy were reviewed. All women underwent hysteroscopy in the same cycle time after TVS. Seventy-six out of 719 patients were excluded from the study and 643 patients were studied. TVS was performed in the follicular phase after cessation of bleeding. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for TVS. Hysteroscopy served as the gold standard.ResultsThe overall sensitivity, specificity, positive and negative predictive values for TVS in the diagnosis of uterine abnormality was 79%, 82%, 84% and 71%, respectively. The sensitivity and PPV of TVS in detection of polyp were 88.3% and 81.6%, respectively. These indices were 89.2% and 92.5%, respectively for fibroma, 67% and 98.3%, respectively for subseptated uterus and 90.9% and 100%, respectively for septated uterus. Adhesion and unicornuated uterus have the lowest sensitivity with a sensitivity of 35% and PPV of 57.1%.ConclusionTVS is a cost-effective and non-invasive method for diagnosis of intrauterine lesions such as polyps, submucosal fibroids and septum. It is a valuable adjunctive to hysteroscopy with high accuracy for identification and characterization of intrauterine abnormalities. This may lead to a more precise surgery plan and performance.

Comparison of transvaginal sonography and double‐contrast barium enema for diagnosing deep infiltrating endometriosis of the posterior compartment

To compare the diagnostic accuracy of transvaginal sonography (TVS) and double-contrast barium enema (DCBE) in the preoperative detection of deep infiltrating endometriosis (DIE) of the posterior compartment. This was a prospective study of 69 consecutive patients with results of pelvic examination or symptoms suggestive of DIE of the posterior compartment. TVS and DCBE were performed before surgery by two groups of physicians specialized in endometriosis, each blinded to the results of the other technique. Imaging data were compared with histopathologic analysis of the resected specimen (gold standard). Sensitivity, specificity, positive and negative predictive values and test accuracies were calculated for both imaging modalities. Sixty seven of the 69 women had a nodule of DIE confirmed at laparoscopy and histopathologic examination. TVS diagnosed DIE in 57 (85%) of these patients, while DCBE revealed the presence of the lesion in 24 (36%) women. For the diagnosis of posterior DIE, TVS and DCBE had, respectively, a sensitivity of 85% and 36%, specificity of 100% and 100%, positive predictive value of 100% and 100%, negative predictive value of 17% and 4% and accuracy of 85.5% and 38%. In patients with pure bowel DIE the sensitivity was 91% and 43%, specificity was 100% and 100%, positive predictive value was 100% and 100%, negative predictive value was 29% and 6% and accuracy was 91% and 45%, respectively. TVS has a much higher sensitivity than does DCBE in detecting the presence of posterior DIE and should thus be regarded as the imaging modality of choice when there is clinical suspicion of the disease.

Preoperative assessment of myometrial and cervical invasion in endometrial carcinoma by transvaginal ultrasound

Objective To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) in preoperative assessment of the depth of myometrial infiltration and the presence of cervical invasion in endometrial carcinoma. Methods 298 consecutive patients with a diagnosis of endometrial cancer were evaluated by TVS within 3 days of surgical intervention. The depth of myometrial invasion was classified into two groups: no or < 50% invasion and ≥ 50% invasion. Invasion of cervix was diagnosed when the neoplastic tissue distended the cervix and showed ill-defined borders with the cervical stroma. Results The sensitivity, specifity, positive predictive value (PPV), negative predictive value (NPV) and overall diagnostic accuracy of TVS in evaluation of the depth of myometrial infiltration were 68.4%, 82%, 65.1%, 84.1% and 77.5%, respectively. While the sensitivity and PPV were significantly higher among grade 3 tumors, the specifity, NPV and accuracy were significantly higher among grade 1 tumors. The sensitivity, specifity, PPV, NPV, and overall diagnostic accuracy of TVS in assessment of the presence or absence of neoplastic tissue in cervix were 76.5%, 99.3%, 86.7%, 98.2% and 98%, respectively. While the sensitivity and PPV were significantly higher among grade 1 tumors, the NPV and accuracy were significantly lower among grade 3 tumors. Conclusion TVS can be considered as a feasible, economical and simple imaging modality with a high diagnostic accuracy for the prediction of cervical involvement. However, it is not a reliable method in estimating the depth of myometrial infiltration.

Diagnostic accuracy of transvaginal sonography (TVS) for non-invasive diagnosis of rectosigmoidal endometriosis – a systematic review and meta-analysis

Objective: The aim of this study was to critically analyze the diagnostic value of TVS for non-invasive, presurgical detection of bowel endometriosis.

Diagnostic accuracy of transvaginal sonography (TVS) for non-invasive diagnosis of rectosigmoidal endometriosis – a systematic review and meta-analysis

Objective: The aim of this study was to critically analyze the diagnostic value of TVS for non-invasive, presurgical detection of bowel endometriosis.

Abnormal uterine bleeding in peri-menopausal age: Diagnostic options and accuracy

Objectives: Various diagnostic techniques have been evolved over the periods to determine the etiology of abnormal uterine bleeding in peri-menopausal women, but their accuracy has not been compared properly. In this study diagnostic accuracy of trans-vaginal sonography (TVS), saline infusion sonography (SIS) and dilatation & curettage (D & C) were compared with hysteroscopic guided biopsy to determine the etiology. Methods: In this study, 252 patients had to undergo trans-vaginal sonography and saline infusion sonography in the same sitting followed by hysteroscopic-guided biopsy and dilatation and curettage. All the materials were sent for histopathological examination. Results: In determining uterine pathology, positive likelihood ratio (PLR) of TVS, SIS and D & C are 2.81, 7.5 and 3.81 respectively considering hysteroscopy as standard. Conclusion: Sensitivity of SIS as a test for detecting pathology in abnormal uterine bleeding (AUB) is high and can be easily performed on out patient basis. D&C has a very low sensitivity and is unacceptable as a screening test for the same conditions.

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.

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.

Diagnostic Accuracy of Transvaginal Sonography in Infertile Patients with Endometrial Polyps

Diagnostic Accuracy of Transvaginal Sonography in Infertile Patients with Endometrial Polyps

Diagnostic accuracy of transvaginal sonography for the diagnosis of adenomyosis: systematic review and metaanalysis

The purpose of this study was to critically appraise the diagnostic accuracy of transvaginal sonography for diagnosing adenomyosis. Computerized databases were used to identify relevant reports published between 1966 and 2007 reporting data on the accuracy of transvaginal sonography for diagnosing adenomyosis in women having hysterectomy. The presence or absence of adenomyosis was confirmed by histopathologic analysis of hysterectomy specimens. The total analysis included 14 trials with 1895 aggregate participants. Two authors independently assessed methodological quality and constructed tables for the assessment of diagnostic measures. Transvaginal ultrasound predicted adenomyosis with a likelihood ratio of 4.67 (95% confidence interval [CI], 3.13-6.17). The overall prevalence of adenomyosis was 27.9% (95% CI, 25.5-30.3). The probability of adenomyosis with an abnormal transvaginal ultrasound was 66.2% (95% CI, 61.6- 70.6). The probability of adenomyosis with a normal transvaginal ultrasound was 9.1% (95% CI, 7.3-11.1). Transvaginal sonography appears to be an accurate diagnostic test for adenomyosis.

Can transvaginal sonography predict infiltration depth in patients with deep infiltrating endometriosis of the rectum?

Patients with deep infiltrating endometriosis (DIE) of the rectum often benefit from surgical treatment, including disc or segmental bowel resection, in terms of pain relief and treatment of infertility. The aim of the present study was to evaluate the diagnostic accuracy of transvaginal sonography (TVS) for preoperative detection of rectal DIE. Furthermore, we aimed to investigate whether TVS can predict infiltration depth based on the distortion of characteristic sonomorphologic features of the rectal wall. Two-hundred patients with symptoms of endometriosis were prospectively assessed by TVS for the presence of rectal DIE before undergoing laparoscopic radical resection of endometriosis including segmental resection of the bowel in affected cases. Sensitivities, specificities, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LHR) and test accuracies were then calculated for the presence of infiltration of the serosal/smooth muscle (S/M) layer and submucosal/mucosal (MUC) layer as demonstrated by TVS and confirmed by histopathological analysis. Rectal endometriosis was confirmed in 43 out of 195 (22%) cases. The sensitivity, specificity, PPV, NPV, test accuracy and positive and negative LHR of TVS on S/M infiltration were 98%, 99%, 98%, 99%, 99%,150.24 and 0.02, respectively, whereas respective data on MUC involvement were 62%, 96%, 53%, 97%, 93.8%, 16 and 0.4. TVS is a highly valuable tool in detecting rectal endometriosis preoperatively. Within this, S/M endometriotic infiltration can be accurately predicted, whereas TVS is less valuable for detection of MUC involvement.

OP06.03: The diagnostic accuracy of transvaginal sonography in tubo‐ovarian abscess: A 2‐year review at the University of the Philippines ‐ Philippine General Hospital

OP06.03: The diagnostic accuracy of transvaginal sonography in tubo‐ovarian abscess: A 2‐year review at the University of the Philippines ‐ Philippine General Hospital

Diagnosis of paraovarian cysts using transvaginal sonography combined with CA 125 determination

Paraovarian cysts arise from the broad ligament between the Fallopian tube and the ovary1 and they appear sonographically as thin-walled, smooth-margined, usually unilocular cysts. In the literature, there are few reports addressing specifically the sonographic evaluation of these cysts, and results are conflicting1-5. We wish to add to the literature on paraovarian cyst diagnosis by reporting our findings on the diagnostic accuracy of transvaginal sonography alone or in combination with serum cancer antigen (CA 125) determination. A total of 315 adnexal masses in 313 non-pregnant women were included in this prospective study. The mean ± SD age of the study population was 41 ± 15 (range, 15–80) years. Two hundred and thirty-six (75%) patients were premenopausal and 79 (25%) were postmenopausal. One or 2 days prior to surgery all women underwent a detailed transvaginal ultrasound examination by an experienced operator and, on the same day, CA 125 was determined. Using B-mode sonography a paraovarian cyst was diagnosed when a unilocular ovoid cyst with an anechoic content and with a thin wall and smooth margin was seen, clearly separate from a normal ovary4, 5. At surgery, all adnexa were examined carefully and all adnexal masses removed. Seventeen of 313 women were found to have paraovarian cysts (prevalence, 5.4%). In these 17 paraovarian cysts the mean ± SD diameter was 47 ± 11 mm. In eight paraovarian cysts suspected on transvaginal sonography (Figure 1), the diagnosis was confirmed by surgery. Of 307 sonographic diagnoses of absence of paraovarian cysts, 298 were confirmed by surgical evaluation. In the nine false-negative cases, the presence of paraovarian cysts was missed because the sonographic appearance resembled that of a simple ovarian cyst (Figure 2). Adhesions or symptomatic adnexal masses were present in 44% of the false-negative cases (three severe pelvic adhesions and one torsion). The diagnostic accuracy of the combined methods for paraovarian cysts is reported in Table 1. The kappa index of 0.63 suggests good agreement between transvaginal sonography and surgery. The association with serum CA 125 measurement did not increase significantly the diagnostic accuracy of B-mode transvaginal sonography. Transvaginal ultrasound image of a paraovarian cyst: sonography showed a thin, smooth inner wall with an anechoic content separated from the normal ipsilateral ovary (calipers). A false-negative case. The presence of a paraovarian cyst was missed because of the failure to identify the ipsilateral ovary. Our study suggests the important role in the diagnosis of paraovarian cysts of transvaginal ultrasound performed by an experienced sonographer, showing good specificity with a good kappa value, but relatively low sensitivity. The co-existing presence of pelvic adhesions in some false-negative cases partially explains this low sensitivity. These data are at odds with those of Kim et al.4, who report a higher sensitivity (71%), and are in partial agreement with the data of Barloon et al.1, who report a very low sensitivity (7%). The absence of false-positive cases in our series is in accordance with the findings of Valentin6 who, in a small series of 167 cases with six paraovarian cysts, found a comparable specificity but a higher sensitivity (83%). Our findings confirm the high positive predictive value of transvaginal sonography in the characterization of several kinds of adnexal mass7, 8. S. Guerriero*, S. Ajossa*, S. Piras*, M. Angiolucci*, O. Marisa*, G. B. Melis*, * Department of Obstetrics and Gynecology, University of Cagliari, Ospedale San Giovanni di Dio, Via Ospedale 46, 09124, Cagliari, Italy

OC117: Transvaginal ultrasound (TVUS) and sonohysterography (SHG) in the preoperative staging of submucous fibroids

Objectives: To assess the diagnostic accuracy of TVUS and SHG in the preoperative staging of submucous fibroids. Methods: Forty-eight women with submucous fibroids diagnosed on TVUS were assessed with SHG within 30 days from surgical treatment. Fibroids were staged according to the angle between the fibroid margins and the endometrium: G0, 90◦. Results were compared with findings at operative hysteroscopy or on pathological examination of the uterus. Results: TVUS allowed staging of the fibroid in 18/48 cases (38%). SHG changed staging in 3 out of these 18 cases (17%). In those 30 women where TVUS did not allow staging of the fibroid, SHG was successful in 26. Overall, SHG was considered diagnostic in 44/48 cases (92%). In all of these 44, the accuracy of staging was confirmed. In 4 cases, SHG was considered non diagnostic due to technical difficulties in obtaining sufficient distension of the endometrial cavity. No patient experienced severe pain, vasovagal reactions or infection. Conclusion: SHG performs better than simple TVUS in the preoperative staging of submucous fibroids. SHG showed complete concordance with hysteroscopic and pathological findings.

3275: The diagnostic accuracy of transvaginal sonography in uterine pathology

Objectives: The purpose of this study is to evaluate the diagnostic accuracy in uterine pathology between transvaginal ultrasound and hysteroscopy. Methods: During the period from January 1995 to May 2005, 277 women underwent hysteroscopy combined with transvaginal ultrasound due to evaluate the cause of infertility and endometrial pathology at Department of Obstetrics and Gynecology in Korea University Hospital. Results: Mean age of the study group was 37.3 and mean parity was 1.13. According to pathologic reports, final diagnosis were normal finding (43.5%), polyp (20.8%), submucosal myoma (11.1%), endometritis (9.7%), endometrial hyperplasia (2.8%) and endometrial cancer (1.4%) etc. The transvaginal ultrasound showed 57.89% sensitivity, 65.26% specificity and 75.0% positive predictive value in detecting endometrial lesions. The sensitivity, specificity and positive predictive value of hysteroscopy were 92.61%, 69.66% and 85.5%, respectively. Overall agreement of transvaginal ultrasound and hysteroscopic finding was 58.7%. Hysteroscopy showed much higher detection rate in case of synechiae and endometritis compared with transvaginal ultrasound. Conclusions: Hysteroscopy was significantly better diagnostic procedure than transvaginal ultrasound. But transvaginal ultrasound also helpful in diagnosis of polyp, submucosal myoma and in evaluation of myometrium and adnexa. So, we concluded that both hysteroscopy and transvaginal ultrasound are useful methods in detection of endometrial lesion.

Uterine Endometrium Assessment Before and After In Vitro Fertilization Cycles: Comparison of Transvaginal Sonography and Hysteroscopy

During the last decade hysteroscopy has become the tool of choice for the evaluation of the endometrial cavity. The objective of this study is to evaluate the diagnostic accuracy of transvaginal sonography(TVS) in detecting uterine cavity disorders before and after in vitro fertilization (IVF) treatment cycles, with reference to hysteroscopy as the gold standard method.

Evaluation of intrauterine disorders by hysteroscopy and transvaginal sonography

ABSTRACTObjective To compare the diagnostic accuracy of transvaginal sonography and hysteroscopy for intrauterine disorders.Design 300 patients were investigated by transvaginal sonography for abnormal vaginal bleeding. Of these, 112 had subsequent hysteroscopic examination and then had concomitant surgery.Results The accuracy of findings at hysteroscopy and transvaginal ultrasonography were compared with the histopathological and surgical results as the gold standard diagnosis. The sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography were 77.4%, 50%, 49% and 78.1%, respectively, for transvaginal ultrasonography, and those of hysteroscopy were 92.3%, 97.4%, 97.3% and 92.6% respectively.Conclusion Hysteroscopy is quick, well tolerated, and more accurate in detecting intrauterine pathology than transvaginal ultrasonography. The uterine cavity can be observed directly under hysteroscopy and this examination can provide a high diagnostic accuracy. Biopsy and treatment can be done at the time of the hysteroscopic examination. Thus it is preferable to transvaginal ultrasound examination.