Diagnostic Accuracy Of Transvaginal Sonography Research Articles

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.

Sonohysterographic staging of submucous myomas

Purpose: To assess the diagnostic accuracy of sonohysterography in preoperative assessment of submucous myomas.Methods: Twenty premenopausal patients with submucous myomas and irregular uterine bleeding and/or infertility were consecutively collected in 12 months. Before surgery, all patients underwent transvaginal sonography (TVS) (Voluson, KRETZ, 5300), with color Doppler evaluation, and sonohysterography (SHG). Number and site of myomas and the myoma–perimetrium distance were considered at TVS. SHG was performed with a 4.7‐mm (14F) intrauterine catheter. Patient compliance to SHG was evaluated by a subjective pain scale. Duration from TVS to completion of the procedure, and volume of saline solution instilled for SHG, were evaluated. Sonographic findings at TVS and SHG were classified as submucous myoma G0, G1 and G2 and compared to hysteroscopic finding. Depending on myoma grading and volume, selected patients underwent preoperative medical treatment with triptorelin (decapeptyl‐ipsen). Hysteroscopic myomectomy was the standard surgical approach. Diagnostic accuracy of TVS and SHG was evaluated.Results: Mean age was 41 years (interquartile range 34–47). Mean BMI was 24 kg/m2 (interquartile range 21–28). Twelve patients reported irregular bleeding, eight infertility. Eleven patients had additional intramural and or subserous myomas. Mean duration time of SHG was 12 min (interquartile range 9–16). Mean volume of sterile solution instilled for SHG was 16 mL (interquartile range 8–24). In all cases, a successful SHG was performed, with no and mild discomfort in 16 (80%) and 3 (11%) patients, respectively. Hysteroscopic findings were compared to TVS and SHG considering the submucous myoma grading. SHG correctly classified all miomas (five cases of G0, 11 cases of G1, five cases of G2). TVS correctly classified all G0 cases, over classified two G1 cases as G2, correctly classified five cases of G2.Conclusions: Sonohysterography was a simple and well tolerated imaging technique, with a diagnostic accuracy comparable to hysteroscopy. We speculate that endometrial sampling performed during SHG could help to exclude coexisting endometrial abnormalities which are likely to occur in larger series.

Comparison of transvaginal ultrasonography and saline infusion sonography for the detection of intracavitary abnormalities in premenopausal women

To compare the diagnostic accuracy of transvaginal sonography (TVS) and saline infusion sonography (SIS) for detecting intracavitary abnormalities in premenopausal women with abnormal uterine bleeding. Consecutive premenopausal women who underwent hysterectomy for abnormal uterine bleeding were included. All women underwent TVS and SIS before their hysterectomy. The findings at TVS and SIS were compared with the findings of the hysterectomy specimen. Sensitivity, specificity, and likelihood ratios were calculated. The results of 50 patients with abnormal uterine bleeding were evaluated. Histological examination revealed normal endometrial histology in 27 patients, submucous myomas in 13 patients and intracavitary polyps in 10 patients. The sensitivity of TVS in directly visualizing intracavitary abnormalities was 61% for a specificity of 96%. The likelihood ratio of presence of an intracavitary abnormality was 16 and the likelihood ratio of absence of such a finding was 0.41. When defining abnormality at TVS as direct visualization of an intracavitary abnormality or an increased endometrial thickness (cut-off level 5 mm), the sensitivity of TVS was 87% for a specificity of 56%, with corresponding likelihood ratios of 2 and 0.23, respectively. The sensitivity and specificity of SIS was 100% and 85% with likelihood ratios of 6 and 0.0, respectively. No intracavitary abnormality was missed by SIS. The diagnostic accuracy of SIS is higher than the accuracy of TVS. A combined approach using endometrial thickness measurement by TVS and, reserving SIS for patients with increased (> 5 mm) endometrial thickness, or endometrium inadequately visualized on TVS, is the optimal method of reducing the hysteroscopy rate.

Role of Preoperative Transvaginal Sonography, Color Flow Imaging, and Doppler Waveform Analysis in Predicting Lymph Node Metastases in Patients with Ovarian Cancer

The aim of this prospective study was to assess the diagnostic accuracy of transvaginal sonography, color flow imaging, and Doppler waveform analysis of adnexal tumors in predicting lymph node metastases in women undergoing laparotomy for ovarian cancer. In 30 consecutive women undergoing pelvic and paraaortic lymphadenectomy due to ovarian cancer, the morphology of the adnexal mass was evaluated preoperatively with transvaginal sonography. Besides conventional gray-scale analysis as well as localization and intensity of angiogenesis, the resistance index (RI) was computed on the arteries detected with color flow imaging. There were 20 (66.7%) patients with negative and 10 (33.3%) patients with positive lymph nodes. The differences in maximal tumor diameter, maximal thickness of tumor wall, echographic structure, or presence of ascites between both groups of patients were not significant. There was no significant difference in the presence or absence of tumor vascularization between both groups of patients. In both groups of patients the mean value of the lowest RI was 0.37. Also, the difference in frequency of RI ≤ 0.40 between both groups of patients was not significant. Using conventional echographic analysis as well as color flow imaging and Doppler waveform analysis of adnexal tumors, according to the author's experience it was not possible to predict lymph node metastases in patients with ovarian cancer.

Diagnostic and therapeutic decision-making with transvaginal sonography for first trimester spontaneous abortion, clinically thought to be incomplete or complete

The purpose of this study was to evaluate the diagnostic accuracy of transvaginal sonography for first trimester spontaneous abortions, thought to be incomplete or complete, in patients with postabortion bleeding or uterine cramping within 5 days of abortion. In a prospective study, 78 patients underwent transvaginal sonography to evaluate the maximum anteroposterior diameter of the uterine cavity on the long axis view and echo pattern of the retained products of conception. Patients were divided into three groups: those with a normal uterine cavity or a uterine cavity with fluid collection without echogenic foci (n = 13, group A), those with a uterine cavity containing fluid mixed with solid components (n = 38, group B), and those with a uterine cavity containing solid components (n = 27, group C). Group A was considered not to have retained products of conception, and the latter two groups were considered to have retained products of conception. Patients in group A were assigned to receive conservative treatment. In groups B and C, patients with significant vaginal bleeding during 48 h of follow-up underwent elective curettage and those with minimal-mild bleeding received conservative management. A total of 73 patients (12 in group A, 35 in group B, and 26 in group C) completed the study. There were no differences in any of selected reproductive data of the groups (p >0.05). In group B, all patients with uterine cavity diameter of 10 mm or greater underwent elective curettage. In group C, all patients with a diameter of the uterine cavity 8 mm or greater underwent elective curettage. The overall complication and patient satisfaction rates were approximately 14% and 88%, respectively. Transvaginal sonographic findings can be used as a decision factor in the management of patients with first trimester spontaneous abortion to reduce the need for an elective curettage by approximately 58%.

Improvement of Diagnostic Accuracy of Transvaginal Ultrasound for Identification of Endometrial Malignancies by Using Cutoff Level of Endometrial Thickness Based on Length of Time Since Menopause

Transvaginal ultrasonography (TVS) is considered useful for identifying endometrial malignancies, but it has a low specificity and a high false-positive rate. The purpose of this study was to improve the specificity of this technique. A total of 300 postmenopausal women were studied. They were clinically evaluated by TVS and endometrial histology. Twenty women yielded pathologic findings on endometrial examination. The mean endometrial thickness was related to the length of time since menopause. For endometria with pathological findings, sonographic measurements of endometria with a thickness of greater than 3 mm exhibited 95.0% sensitivity, 68.5% specificity, 19.4% positive predictive value, and 99.4% negative predictive value. If a 4-mm cutoff limit was used for <5 years since menopause and a 3-mm cutoff limit was used for ≥≥5 years since menopause, 95.0% sensitivity, 78.1% specificity, 25.7% positive predictive value, and 99.5% negative predictive value were obtained. The specificity and false-positive rate were improved when the cutoff limit was decided based on the length of time since menopause. The cutoff level of the endometrial thickness for detection of endometrial malignancies should be decided based on the length of time since menopause.

Differential Diagnosis of Adnexal Masses with Transvaginal Sonography, Color Flow Imaging, and Serum CA 125 Assay in Pre- and Postmenopausal Women

The aim of the present study was to compare the diagnostic accuracy of transvaginal sonography, color flow imaging, and serum CA 125 assay in pre- and postmenopausal women undergoing laparotomy for a clinical diagnosis of an adnexal mass. In 109 consecutive women, the morphology of the mass was evaluated with transvaginal sonography, the pulsatility index (PI) was computed on the arteries detected with color flow imaging, and blood samples were obtained for CA 125 assay. Descriptive statistics were performed for the whole series and according to the menopausal status. The diagnostic accuracy of transvaginal sonography was significantly higher in premenopause than in postmenopause (97 versus 85%,P< 0.05). In premenopause, the diagnostic accuracy of transvaginal sonography was significantly higher than that of PI measurement (73%,P< 0.002) and serum CA 125 assay (87%,P< 0.05). In postmenopause, the three tests showed a similar diagnostic accuracy (85, 82, and 79%, respectively). In conclusion, the addition of further tests besides transvaginal sonography is not warranted in premenopausal women with an adnexal mass, but they seem to be useful in postmenopause.

Assessment of Adnexal Masses by Transvaginal Sonography and Serum CA125 Assay in Pre- and Postmenopausal Women

Objective: To compare the diagnostic accuracy of transvaginal sonography and serum CA125 assay for a clinical diagnosis of malignant nature of adnexal masses. Materials and methods: This prospective study was carried out in the department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period of January 2001 to December 2002. The study included 86 patients scheduled for laparotomy for an adnexal mass. Among them, 56 patients were pre- menopausal and 30 were postmenopausal. Adnexal masses had been diagnosed by bimanual pelvic examination and by both transabdominal and transvaginal sonography before planning surgery. Results: Considering separately the women with benign or malignant masses, the sensitivity and specificity of transvaginal sonography for the diagnosis of malignant ovarian condition in premenopausal women were 80% and 96.08% and in postmenopausal women these were 60% and 80%, positive and negative predictive values in premenopausal women were 66.67% and 98.00%, whereas in postmenopausal women those were 60% and 80%. Therefore the sensitivity, specificity, positive and negative predictive values of transvaginal sonography in premenopausal women were higher than in postmenopausal women. The diagnostic accuracy of transvaginal sonography in premenopausal women was 94.64% and in postmenopausal women was 73.33%. The sensitivity, specificity, positive predictive value and the diagnostic accuracy of serum CA125 for the diagnosis of malignant ovarian condition in postmenopausal women were higher than premenopausal women. But the negative predictive value in premenopausal women was higher 94.87% than in postmenopausal women 88.90%. Conclusion: Transvaginal sonography used alone is the best method for differentiating between benign and malignant adnexal masses with a good diagnostic accuracy in premenopausal women in addition to clinical symptoms and pelvic examination. The good diagnostic accuracy of transvaginal sonography in premenopausal women may suggest that the addition of further test is not warranted. On the contrary in postmenopausal women, lower diagnostic accuracy of transvaginal sonography may require help of further test to improve it. Keyword: Adnexal mass; Transvaginal sonography; Serum CA125. Bangladesh J Obstet Gynaecol, 2009; Vol. 24(2) : 56-62 DOI: http://dx.doi.org/10.3329/bjog.v24i2.8529