Transvaginal Sonographic Evaluation Research Articles

A Comparative Analysis of Diagnosis and Measurement of Uterine ‘Niche’ Performed By Non-Specialist and Specialist Sonographers

<h3>Study Objective</h3> To compare the diagnosis and evaluation of a niche done by ultrasonographic non-specialist vs. specialist in women after cesarean delivery using two dimensional (2D) transvaginal ultrasound. <h3>Design</h3> A cohort study. <h3>Setting</h3> Single tertiary care center. <h3>Patients or Participants</h3> Women after cesarean delivery that were operated during January 2011 to December 2018. <h3>Interventions</h3> All women completed a 2D transvaginal sonographic evaluation of the uterine scar and a questionnaire regarding symptoms associated to niche presence. Examinations were performed by one of two non-specialist ultra-sonographers, who completed a short training aimed specifically for the evaluation of uterine scar integrity and characteristics. Pictures and video of the examinations were saved and evaluated by an ultrasonographic specialist using ImageJ processing program with endometrium width as reference for measurements. The last was blinded to the non-specialist examination results. Data are presented as median and interquartile range. <h3>Measurements and Main Results</h3> Fifty-three women were included in the study. Median age was 34(IQR 31-39) years. Mean cesarean delivery rate was 1(1-3) with a mean time from surgery of 11(10-11) months. While comparing non-specialist to specialist measurements of the niche area, length [6.5(5.60-8.12) vs. 9.13(6.92-10.10) mm, p=0.003] and adjacent myometrial thickness (AMT) [10.85(8.62-12.90) vs.12.48(9.95-16.08) mm, p=0.01] were both found statistically higher in the specialist measurements. Nevertheless, no differences were found in the residual myometrial thickness (RMT) [5.05(3.92-6.57) vs. 4(2.63-7.81) mm, p=0.29] nor in the depth [3.5(2.6-5.9) vs. 3.58(2.34-4.93) mm, p=0.48] measurements. Symptoms were not found to be associated with any of the niche measurements for both measurers. Estimation of significant niche, defined by low RMT or impression of profound uterine defect requiring additional evaluation, was also comparable between measurers [34%(n=18) vs. 19%(n=10), p=0.07]. <h3>Conclusion</h3> Evaluation of a niche measurements in women after caesarean delivery using two dimensional (2D) transvaginal ultrasound performed by ultrasonographic non-specialist is comparable to specialist.

Endometrial assessment by transvaginal ultrasonography and correlation with histopathology among post menopausal women

Background: Transvaginal ultrasonography has increased the reliability of imaging diagnosis of women with endometrial pathologies and this technique has become widely used to evaluate endometrial thickness in women with postmenopausal bleeding.&#x0D; Materials and methods: 359 women presenting with history of at least three months amenorrhea were undergone transvaginal ultrasonography with measurement of endometrial thickness and uterine size. Endometrial biopsies were taken in 69 cases (19.2%) only.&#x0D; Results: The median age of patients was 53 years with the age range of 42 years to 81 years. Abdominal pain was the commonest symptoms followed by backache. 3/69 cases with histopathological diagnoses had normal sized uterus, while 66 cases had bulky (&gt;6.0 cm) uterus. 58/69 cases showed &gt; 5 mm thick endometrium and the endometrium was abnormal in 31/69 cases. The sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography to detect abnormal endometrium were 91.2%, 22.9%, 53.4% and 72.7% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography to detect endometrial hyperplasia and carcinoma were 100%, 17.5%, 10.3% and 100% respectively.&#x0D; Conclusions: Transvaginal sonographic evaluation of endometrial thickness and uterine size is useful for exclusion of endometrial pathology and to avoid unnecessary invasive surgical procedures.

The Added Contribution of Transvaginal Sonographic Evaluation of Amniotic Fluid Index

The Added Contribution of Transvaginal Sonographic Evaluation of Amniotic Fluid Index

P18.08: Bowel resection for DIE: 2D and 3D transvaginal sonographic evaluation of residual disease and associated symptoms

P18.08: Bowel resection for DIE: 2D and 3D transvaginal sonographic evaluation of residual disease and associated symptoms

Transvaginal sonographic evaluation of cervical length in the second trimester of asymptomatic singleton pregnancies, and the risk of preterm delivery.

To evaluate cervical length in asymptomatic women with singleton pregnancies in the second trimester by means of transvaginal ultrasonography, and to examine the relation between cervical length and spontaneous preterm delivery. Observational, prospective study. A university hospital and a county hospital in Western Sweden. A total of 2122 asymptomatic women with live singleton pregnancies without fetal anomalies. Cervical length was measured at between 16 and 23 weeks of gestation by means of transvaginal ultrasonography. Data were analysed using logistic regression analysis. Cervical length in relation to spontaneous preterm delivery <34 weeks (primary outcome) and <37 weeks of gestation (secondary outcome). Eleven women had a cervical length of ≤25 mm (0.5%) and 73 women had a cervical length of ≤30 mm (3.4%). Spontaneous preterm delivery at <34 weeks occurred in 22/2061 women (1.1%) and at <37 weeks in 87/2061 women (4.2%). There was a significant association between cervical length and spontaneous preterm delivery at <34 weeks (odds ratio 1.78; 95% confidence interval 1.19-2.65 for a decrease of cervical length by 5 mm) but no significant association at <37 weeks. The rate of short cervical length of ≤25 mm was lower than expected. The study confirmed the increased risk of spontaneous preterm delivery in women with a short cervix, although the analysis was based on only a few cases. In Sweden, a larger study is needed to evaluate the prevalence of short cervical length and the possible association with preterm delivery before universal screening can be recommended.

Predictive model for spontaneous preterm labor among pregnant women with contractions and intact amniotic membranes

To determine a predictive model for supporting decisions relating to the prognosis for women presenting with preterm labor and intact membranes. We conducted a prospective observational cohort study on 70 pregnant women at between 22 and 34 weeks of gestation. Transvaginal sonographic evaluation on the cervix was performed once on women who had completed a course of parenteral tocolysis. The sonographic parameters of cervical length measurement and presence of cervical glandular area were obtained. The outcome variable was occurrences of preterm delivery (<35 weeks). Using a univariate logistic regression model, the coefficients of each independent variable were first estimated. To construct the predictive model, multivariate logistic regression containing all the selected variables that might be related to preterm delivery was used as the starting point. Accuracy, sensitivity, specificity and predictive values were used to measure associations of predicted probabilities and to check the ability of the model to predict outcomes. The predictive analyses were based on logistic regression models, with calculation of odds ratios and 95 % confidence intervals. The incidence of preterm delivery was 32.80 % (23/70). After validation, the predictive model proposed showed accuracy of 87.88 %, sensitivity of 78.26 % and specificity of 93.02 %. The model presented good accuracy with correspondence between predictions and observations, and has the capacity to become a useful tool for management of pregnant women with preterm labor and intact amniotic membranes.

Transvaginal Sonographic Evaluation of the Cervix in Asymptomatic Singleton Pregnancy and Management Options in Short Cervix

Preterm delivery (PTD), defined as birth before 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Evaluation of the cervical morphology and biometry with transvaginal ultrasonography at 16–24 weeks of gestation is a useful tool to predict the risk of preterm birth in low- and high-risk singleton pregnancies. For instance, a sonographic cervical length (CL) > 30 mm and present cervical gland area have a 96-97% negative predictive value for preterm delivery at <37 weeks. Available evidence supports the use of progesterone to women with cervical length ≤25 mm, irrespective of other risk factors. In women with prior spontaneous PTD with asymptomatic cervical shortening (CL ≤ 25 mm), prophylactic cerclage procedure must be performed and weekly to every two weeks follow-up is essential. This article reviews the evidence in support of the clinical introduction of transvaginal sonography for both the prediction and management of spontaneous preterm labour.

Transvaginal sonographic evaluation at different menstrual cycle phases in diagnosis of uterine lesions

Purpose:Intrauterine lesions (IULs) are a common finding in women of reproductive age, particularly infertile women. Transvaginal sonography (TVS) is a popular tool for IUL detection, but there are conflicting data with respect to its accuracy.Methods:Five hundred and six women were enrolled into the study. Of these, 496 underwent hysterosalpingography and subsequent TVS six different times during the course of their menstrual cycle. If a lesion was detected, it was further evaluated by sonohysterography (SHG) and hysteroscopy.Results:Of 496 women, 41 were shown to have IULs by TVS and those lesions were confirmed in 39 by SHG and hysteroscopy. All 39 lesions were detectable during the ovulatory and early luteal phase (days 16–19) of the menstrual cycle. Accuracy of TVS during different phases was largely dependent on the size of the lesion. TVS falsely detected two lesions and missed fine adhesions in two patients.Conclusion:Accuracy of TVS in detection of IULs is highly dependent on the menstrual cycle phase, with the ovulatory and early luteal phase being the optimal time for this examination.

Combined Clinical and Ultrasonographic Work-up for the Diagnosis of Retained Products of Conception

Retained products of conception (POC)—a relatively common finding after vaginal and cesarean delivery as well as termination of pregnancy—is a major diagnostic challenge. Sonohysterography has been shown to diagnose retained POC with nearly a 100% success rate, but has a number of drawbacks including the need for special equipment and considerable operator experience, its invasiveness, and high cost. Ultrasonography is a common part of the gynecologic examination and widely available but has not been useful for diagnosis of retained POC. However, with improved ultrasonographic technology and experience with its use, transvaginal sonographic (TVS) evaluation has shown increasing promise for retained POC diagnosis. The investigators conducted a retrospective chart review to assess the accuracy of an evaluation protocol based on clinical treatment with uterotonics combined with TVS evaluation for the detection of retained POC. The participants were 339 women referred to an obstetrics ultrasound unit because of abnormal bleeding, fever, abdominal pain, or a combination of these symptoms after labor or pregnancy termination. Upon enrollment, all participants underwent a TVS evaluation and were divided into 2 groups: one with negative TVS results and the other with positive results. Patients with negative results were discharged and instructed to return to the hospital if bleeding, abdominal pain, or fever recurred. Those with positive results were treated conservatively with methyl ergometrine for 5 days and reexamined with TVS. Patients with positive results in the second TVS evaluation were referred for curettage and pathological examination of the uterine content. The sensitivity, specificity, and positive and negative predictive values were determined for the total cohort. A total of 269 patients (79.4%, 269/339) were negative for retained POC and were discharged. The remaining 20.6% (70/339) with positive results received conservative treatment with methyl ergometrine and were reeval- uated with TVS. For 33 (47.1%) of the 70 positive patients, the results were negative at the second TVS, leaving 37 patients who remained positive. These 37 positive patients and an additional 2 (0.07%) who had been negative initially but were revaluated because of recurrent bleeding underwent uterine curettage. The sensitivity for identifying retained POC with TVS was 94% and the specificity was 98%; the positive and negative predictive values were 84% and 99%, respectively. These findings indicate that that the proposed protocol provides an accurate and highly sensitive diagnosis of retained POC that may help avoid unnecessary surgery in nearly 50% of women with suspected retained POC after labor or abortion.

Clinical and Transvaginal Sonographic Evaluation of the Prostate in Transsexual Women

To assess feasibility and diagnostic performance of prostate examination through transvaginal palpation and transvaginal ultrasound in transsexual women (TSW). Fifty TSW who were at least 6 months' posttransition were recruited in a University Hospital. Speculum examination and digital vaginal examination were performed by a gynecologist. Transvaginal ultrasound of the prostate was performed by a radiologist. The information gathered included: ease of insertion of the speculum, vaginal length, palpability of the prostate, vaginal mobility and presence of scar tissue, ease of introduction of the ultrasound probe, ability to visualize prostate and seminal vesicles, echogenicity of the peripheral zone and the central gland, presence of calcifications and delineation of prostatic capsule, attitude toward gynecologic examinations, and anticipated and experienced painfulness of the different examinations. Speculum examination was possible in all but 1 patient and was easy in 78% of the patients. Median vaginal length was 7 cm. A regular digital vaginal examination was possible in 44% of the patients, the vagina was rather mobile and with limited scar tissue on average. In 48% of the patients, the prostate was palpable. In 94% of the patients, the prostate was visible on transvaginal ultrasound. Mean prostate volume was 14 mL, calcifications were present in 33%, and none had cysts. Capsule of the prostate was well delineated in 74% and seminal vesicles were visualized in 80%. All examinations were very well tolerated and nearly painless. Gynecologic examination and prostate assessment were acceptable to TSW. Transvaginal palpation of the prostate is of poor clinical value, yet transvaginal ultrasound allows for proper evaluation of the prostate status.

Transvaginal sonographic evaluation of subendometrial–myometrial contractility in women using a copper-releasing intrauterine device

BackgroundThe aim of this study was to determine the effects of a copper-releasing intrauterine device (IUD) on myometrial contractility midway through the menstrual cycle. Study DesignUterine peristalsis was studied midway through the cycle with transvaginal sonography in two groups of women, a control group and women in whom a copper-releasing IUD had been inserted. ResultsThe results showed that 12 months after insertion, no uterine motility could be detected with sonography in any of the women with an IUD, but motility did occur in all the controls. ConclusionsSubendometrial–myometrial contractility midway through the menstrual cycle had been abolished in patients with a copper-releasing IUD. The loss of motility may inhibit sperm transport from the cervix to the oviduct and account for at least part of the contraceptive effect of these devices.

OC187: Transvaginal sonographic cervix and lower uterine segment evaluation for medical induction of labor

OC187: Transvaginal sonographic cervix and lower uterine segment evaluation for medical induction of labor

Holoprosencephaly at 9 Weeks 6 Days in a Triploid Fetus

Received October 29, 2006, from the Fetal Medicine Center (W.S., I.L.), Department of Obstetrics and Gynecology, and Cytogenetics Laboratory (C.B.), Clinica Las Condes, Santiago, Chile. Manuscript accepted for publication November 2, 2006. We thank Filiberto Guerra, MD, for performing the postmortem examination and Medison Co, Ltd (Seoul, Korea) for an equipment loan. This work was supported by Sociedad Profesional de Medicina Fetal “Fetalmed” Limitada, Chile. Address correspondence to Waldo Sepulveda, MD, Fetal Medicine Center, Clinica Las Condes, Casilla 208, Santiago 20, Chile. E-mail: fetalmed@yahoo.com Abbreviations 3D, 3-dimensional oloprosencephaly is a rare intracranial abnormality arising from failure of the prosencephalon to cleave during early embryonic life, which results in different degrees of lateral ventricular fusion and facial defects.1 This condition is classified according to brain structures into lobar, semilobar, and alobar, the latter being the most severe form.1 In this report, we describe one of the earliest prenatally diagnosed cases of holoprosencephaly, in which 3-dimensional (3D) imaging was used to assist in the diagnosis. A 27-year-old woman, gravida 4, para 2, spontaneous aborta 1, was referred at the menstrual age of 9 weeks 6 days for sonographic evaluation because of a suspected fetal brain anomaly detected at the dating scan. Her medical and obstetric histories were unremarkable, and the current pregnancy was otherwise uncomplicated. Transvaginal sonographic evaluation at referral revealed a live singleton fetus with a crown-rump length of 34 mm and a large anechoic area behind the forehead (Figure 1). With the assistance of 3D eXtended Imaging technology (Accuvix XQ; Medison Co, Ltd, Seoul, Korea), including Multislice View and Volume CT, multiple sections of the fetal brain were obtained, which helped in selecting the best plane to show the single ventricular cavity and fused thalami (Figure 2). A follow-up scan 1 week later revealed a 45-mm live fetus with alobar holoprosencephaly, midfacial hypoplasia, small orbits, a suspected small omphalocele, and an increased nuchal translucency thickness of 5.6 mm (Figure 3). The placenta appearance was normal. Trophoblast culture obtained from chorionic villus sampling revealed a 69,XXY karyotype. The patient miscarried at 13 weeks. Pathologic examination of the fetus and placenta confirmed the prenatal diagnosis (Figure 4).

Ultra-sonografia transvaginal do colo para a predição do parto pré-termo em pacientes sintomáticas com bolsa íntegra

OBJETIVOS: avaliar a utilidade do comprimento cervical ultra-sonográfico para a predição do parto em gestantes com contrações uterinas persistentes e bolsa íntegra. MÉTODOS: realizou-se estudo observacional, prospectivo, do tipo coorte no qual foram incluídas 45 gestantes internadas em nossa instituição entre a 22ª e a 34ª semana. Ultra-sonografia transvaginal do colo foi realizada uma única vez, após completado um ciclo de tocólise endovenosa, com aferição do comprimento, conforme critérios descritos previamente. Os achados ultra-sonográficos não foram utilizados para o diagnóstico ou conduta obstétrica. O desfecho estudado foi a ocorrência de parto pré-termo (<37 semanas). A análise estatística fundamentou-se em método de regressão logística univariada para determinar a significância do comprimento cervical para a predição do parto pré-termo. O nível de significância adotado foi de 5% (p<0,05) e o intervalo de confiança foi de 95% (IC 95%). RESULTADOS: a incidência de parto pré-termo foi de 51,1% (23/45). O comprimento cervical associou-se de forma significativa ao desfecho da gestação (p<0,0001). Após construção de curva característica operatória do receptor, um comprimento cervical de 20 mm revelou-se como melhor ponto de corte para a predição do parto pré-termo (sensibilidade: 86,9%; especificidade: 81,8%; valor preditivo positivo: 83,3% e valor preditivo negativo: 85,7%). A área calculada abaixo da curva característica operatória do receptor foi de 0,91 (IC 95%: 0.79-0.97; p<0,0001). CONCLUSÕES: nas mulheres com contrações uterinas persistentes e bolsa íntegra, em tratamento para trabalho de parto pré-termo, um comprimento cervical inferior a 20 mm demonstrou maior probabilidade de parto pré-termo. A ultra-sonografia transvaginal pode melhorar a acurácia diagnóstica em gestantes sintomáticas.

Transvaginal Sonographic Evaluation of Cervix Length After Cervical Conization

The purpose of this study was to evaluate transvaginal sonographic cervical length before and after cervical conization for squamous intraepithelial lesions. Between November 2002 and October 2004, all women undergoing conization by either cold-knife conization or a loop electrosurgical excision procedure for squamous intraepithelial lesions were prospectively enrolled in this study. Cervical length was measured by transvaginal sonography (TVS) before and after conization. A total of 48 women were studied before and after a mean of 7 days after conization. Complete excision was achieved in 41 patients, and endocervical margins were involved in 7 patients. Mean TVS cervical length was significantly shorter after than before conization (mean +/- SD, 22.7 +/- 6.9 versus 26.7 +/- 8.1 mm; P < .001). The correlation coefficient between cone specimen length and postoperative length was r = 0.75 (P < .001). Mean TVS cervical lengths were 24.3 +/- 6.7 mm in the group of women who underwent a loop electrosurgical excision procedure and 20.7 +/- 9.4 mm in the group of women who underwent cold-knife conization (P = .13). Transvaginal sonographic measurement of cervical length after conization is well correlated with cone specimen length.

Laparoscopic removal of endometriomas: sonographic evaluation of residual functioning ovarian tissue

Objective The aim of this study was to determine whether and to what extent laparoscopic removal of ovarian endometriotic cysts is a tissue-sparing procedure. Study design At the University Hospital, 77 women of reproductive age with endometriomas and 55 with dermoid cysts underwent laparoscopic removal of the ovarian disease by stripping. Within 1 month before and within 36 months after surgery all patients underwent transvaginal sonographic evaluation of ovarian volume of the endometriomas or dermoid cysts and measurement of the residual ovarian tissue. Results The residual ovarian volume after surgery was significantly less for the endometrioma group than for the dermoid group. Comparison of the volume of the treated ovary with that of the untreated contralateral ovary showed a significant difference (4.3±2.3 cm 3 vs 9.7±3.9 cm 3) only in the endometrioma group. Conclusion Ovarian stripping of endometriomas, but not of ovarian dermoids, is associated with a significant decrease in residual ovarian volume which may result in diminished ovarian reserve and function.

Laparoscopic removal of endometriomas: Sonographic evaluation of residual functioning ovarian tissue

Objective. The use of the laparoscopic approach, in particular the technique, has been questioned because it could involve excessive removal of ovarian tissue with loss of follicles. The aim of this study was to determine how and if the laparoscopic removal of ovarian endometriotic cysts is a tissue-sparing procedure. Setting. University Hospital. Patients. Fifty-two patients in fertile age with an ovarian endometrioma, correctly diagnosed by sonography, undergoing laparoscopic removal by stripping. Interventions. Laparoscopic removal of ovarian endometriomas by stripping and transvaginal sonographic (TVS) evaluation of residual ovarian tissue. Measurements and Main Results. Within one week before surgery all recruited patients underwent TVS evaluation of ovarian volume, size and morphology of the endometriotic cyst and measurement of the surrounding ovarian cortex. Within 6-12 months after laparoscopic excision, TVS measurements of residual ovarian tissues were obtained. Mean cyst diameter was 4.7+2.2 cm (range 2.1-9.2 cm). Ovarian residual cortex surrounding the cyst was ultrasonographically lower than the previous evaluation. Conclusion. Although laparoscopic approach is still the less invasive technique in treating ovarian endometriosis, it appears aggressive in terms of injuring the residual ovarian tissue.

Laparoscopic Approach to Dermoid Cysts: Combined Surgical Technique and Ultrasonographic Evaluation of Residual Functioning Ovarian Tissue

Study Objective To estimate how and if laparoscopic removal of ovarian dermoid cysts is a tissue-sparing procedure. Design Prospective study (Canadian Task Force classification II-2). Setting University-associated hospital. Patients Fifty-five women. Intervention Laparoscopic removal of ovarian dermoid cysts by a combination of hydrodissection and blunt dissection, and transvaginal sonographic (TVS) evaluation of residual ovarian tissue. Measurements and Main Results Within 1 week before surgery all recruited patients underwent TVS evaluation of ovarian volume, size, and morphology of dermoid cysts and measurement of surrounding ovarian cortex. Mean cyst diameter was 5.5 ± 2.2 cm (range 2.1–15.0 cm). Within 6 to 12 months after laparoscopic excision, TVS measurements of residual ovarian tissues were obtained. Ovarian residual cortex surrounding the cyst was not visible at TVS in 24 ovaries, whereas in 56 ovaries residual tissue volume was greater than 3 cm 3 after laparoscopic excision. Conclusion We propose laparoscopic removal of dermoid cysts by combining hydrodissection and blunt dissection with maximum tissue sparing, even when the cyst seems to fill the ovary and no surrounding ovarian cortex can be seen on ultrasound.

Ultrasound assessment of endometrial thickness and endometrial polyps in women on hormonal replacement therapy

Objective: This study was performed to evaluate the thickness and the sonographic features of the endometrium in postmenopausal women on hormone replacement therapy (HRT). Study Design: This prospective study was based on 483 vaginal ultrasound examinations performed in 238 consecutive postmenopausal women on HRT. Results: Endometrial polyps were diagnosed by ultrasound in 16.3% of the patients; 43.6% were asymptomatic. In the nonpolyp group, a significant difference in endometrial thickness between sequential and continuous schemes was found. In sequential HRT, a three-layer ultrasound pattern of the endometrium was seen in 47% of the women in the estrogen-alone phase of cycle versus 11% in the estrogen-progestogen phase. Conclusion: Patients on HRT need other reference values for endometrial thickness compared with postmenopausal women without HRT. In women on sequential HRT, a transvaginal sonographic evaluation performed in the estrogen-alone phase of cycle may optimize the accuracy for focal lesion detection. The significance of the incidental finding of polyps in an important number of asymptomatic women on HRT remains unsettled. (Am J Obstet Gynecol 2003;188:1249-53.)

Value of sonomorphological criteria of the endometrium in women with postmenopausal bleeding: a multivariate analysis

This study was performed to examine whether an improvement in the transvaginal sonographic evaluation of the endometrium is possible by the addition of sonomorphological criteria to the measurement of endometrial thickness in women with postmenopausal bleeding. Various sonomorphological criteria were analyzed prospectively in 321 patients with postmenopausal bleeding. In a logistic regression model relevant criteria were selected and a diagnostic formula for differentiation of endometrial sonographic findings was derived. The criteria of endometrial structure, endometrial-myometrial border and endometrial thickness were significant for the differentiation of malignancy. These results allowed an estimation of the probability of malignancy for each sonographic endometrial finding. Using the cut-off point of 0.1 for the probability of malignancy, the sensitivity and specificity were 96.8% and 61.9%, respectively, with an accuracy of 72.3%. In contrast, the differentiation by endometrial thickness as the sole criterion (cut-off point > or = 5 mm) achieved a sensitivity of 97.9% and a specificity of 33.2%, with an accuracy of 52.3%. A useful diagnostic formula based on sonomorphological and metric criteria for endometrial differentiation was obtained. The specificity and accuracy increased with a minimal loss of sensitivity. However, estimates for sensitivity, specificity, and accuracy may be overoptimistic because they were derived from the same data used for development of the model.