Use Of Transvaginal Ultrasonography Research Articles

VP46.21: Usefulness of transvaginal ultrasonography of the cervical canal in the screening of pregnant women at risk of premature labour

VP46.21: Usefulness of transvaginal ultrasonography of the cervical canal in the screening of pregnant women at risk of premature labour

A Race-Conscious Analysis of the Use of Transvaginal Ultrasonography in the Evaluation of Postmenopausal Bleeding

A Race-Conscious Analysis of the Use of Transvaginal Ultrasonography in the Evaluation of Postmenopausal Bleeding

Estudo anatomopatológico dos pólipos endometriais diagnosticados por histeroscopia

A incidência de malignidade em formações polipoides do endométrio tem sido estudada recentemente em diversos países, encontrando-se entre 0 e 4,8% na maioria dos trabalhos. A crescente utilização da ultrassonografia transvaginal mesmo em mulheres assintomáticas aumentou a frequência desse diagnóstico em nosso meio. Diversos estudos recomendam a exérese e a avaliação histológica de toda a lesão polipoide visualizada no exame histeroscópico para exclusão de malignidade, porém essa abordagem não é consensual, sobretudo quando as pacientes são jovens ou assintomáticas. O presente estudo avaliou 458 resultados de exames anatomopatológicos de pacientes com diagnóstico histeroscópico de pólipo endometrial, admitidas em laboratório de patologia geral. O diagnóstico histeroscópico confirmou-se em 79,9% dos casos (76,0–83,3%, IC95%) e a prevalência do adenocarcinoma foi de 5,25% (3,7–7,9%, IC95%) em todos os exames. As atipias celulares foram identificadas em hiperplasias glandulares simples ou complexas em 1,9% do total de pólipos endometriais (0,9–3,8%, IC95%). A idade maior ou igual a 51 anos comportou-se como variável fortemente associada à maior prevalência de lesões malignas e pré-malignas, que nesse grupo etário representou 12,2% dos diagnósticos. Comparando-se ao grupo de pacientes com idade entre 41 e 50 anos, a razão de prevalência foi de 2,96, com odds ratio de 3,23. A prevalência de 6,99% de lesões pré-malignas e malignas encontrada na população geral do estudo em pauta justifica a preconização da exérese histeroscópica e o exame histopatológico de todo achado na cavidade endometrial, independentemente do tamanho ou do aspecto macroscópico benigno que o pólipo possa aparentar.

Modern evaluation of abnormal uterine bleeding

Abnormal uterine bleeding in women older than age 40 years, and certainly in menopausal patients, mandates evaluation, mainly to exclude cancer and hyperplasia, but also to better diagnose the source of the bleeding to appropriately manage the patient. In the past, dilation and curettage was the mainstay of diagnosis. This gave way to in-office suction pump-generated biopsies. Most recently, disposable biopsy instruments with their own internal piston to generate suction have become the standard of care. Rarely has such a technique received such widespread acceptance with such limited validation. Transvaginal ultrasonography, when technically feasible, is a noninvasive way to image the endometrial cavity. Saline-infusion sonohysterography is a subset of transvaginal ultrasonography reserved for patients in whom an adequate endometrial echo is not seen or when an endometrial echo is seen but not sufficiently thin. Appropriate understanding and use of transvaginal ultrasonography and addition of sonohysterography when necessary can allow a clinical algorithm that can triage patients with abnormal uterine bleeding to (1) no anatomic pathology best treated expectantly; (2) a global endometrial process, in which case random blind endometrial sampling is appropriate; or (3) a focal endometrial abnormality in which case endometrial sampling should be done with the visualization offered by hysteroscopy. Newer disposable office hysteroscopes finally allow office hysteroscopy to be done as a truly “point-of-care option.” Finally, the incidence of thick endometrial echo found incidentally in postmenopausal women with no bleeding is extremely high (10–17%) and should not trigger automatic invasive endometrial evaluation.

Late diagnosis of a cesarean scar pregnancy: Rare form of an ectopic pregnancy case

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy, which occurs with the placement of pregnancy to the defective myometrium area in the old cesarean scar. The incidence of CSP has been increasing in recent years because of the increasing cesarean rates and the more frequent use of transvaginal ultrasonography in early pregnancy all over the world. We present here our clinical approach in the cesarean scar pregnancy diagnosed at the 14th week of pregnancy at the age of 39, who had previously undergone 3 cesarean section operations.

Role of Transvaginal Ultrasonography in the evaluation of Uterine Fibroids: a regional observation in Bangladesh

Uterine fibroids, also known as leiomyomas, are the most common uterine neoplasms. Although benig, they can be associated with a significant number of morbidity and are the most common indication for hysterectomy. Transvaginal ultrasonography (TVS) has become essential in the diagnosis and management of the uterine fibroids. TVS provides a detailed examination of uterus and ovaries. However, there is no nation-wide and regional clinical study on the use of TVS for the evaluation of uterine fibroids in Bangladesh. In this work, a cross-sectional study toob serve the role of TVS in the evaluation of uterine fibroids in a region of Bangladesh (Greater Mymensingh). In the diagnosis of uterine fibroids by TVS, we observed that 35(81.4%) cases (out of 43) are fibroids and 8 (18.6%) cases are non-fibroids. In histopathological diagnosis, we found 36 (83.7%) cases are uterine fibroids, and 7 (16.3%) cases are without fibroids. In this study, TVS diagnosed uterine fibroids with a sensitivity of 94.4%, the specificity of 85.71%, the accuracy of 97.6%, the positive predictive value of 97.1% and negative predictive value of 75%. The results demonstrate that TVS has the potential to become a useful imaging tool for the evaluation of uterine fibroids.
 CBMJ 2018 July: Vol. 07 No. 02 P: 17-23

Committee Opinion No. 716 Summary: The Role of the Obstetrician-Gynecologist in the Early Detection of Epithelial Ovarian Cancer in Women at Average Risk.

Ovarian cancer is the second most common type of female reproductive cancer, and more women die from ovarian cancer than from cervical cancer and uterine cancer combined. Currently, there is no strategy for early detection of ovarian cancer that reduces ovarian cancer mortality. Taking a detailed personal and family history for breast, gynecologic, and colon cancer facilitates categorizing women based on their risk (average risk or high risk) of developing epithelial ovarian cancer. Women with a strong family history of ovarian, breast, or colon cancer may have hereditary breast and ovarian cancer syndrome (BRCA mutation) or hereditary nonpolyposis colorectal cancer (Lynch syndrome), and these women are at increased risk of developing ovarian cancer. Women with these conditions should be referred for formal genetic counseling to better assess their cancer risk, including their risk of ovarian cancer. If appropriate, these women may be offered additional testing for early detection of ovarian cancer. The use of transvaginal ultrasonography and tumor markers (such as cancer antigen 125), alone or in combination, for the early detection of ovarian cancer in average-risk women have not been proved to reduce mortality, and harms exist from invasive diagnostic testing (eg, surgery) resulting from false-positive test results. The patient and her obstetrician-gynecologist should maintain an appropriate level of suspicion when potentially relevant signs and symptoms of ovarian cancer are present.

Committee Opinion No. 716: The Role of the Obstetrician-Gynecologist in the Early Detection of Epithelial Ovarian Cancer in Women at Average Risk.

Ovarian cancer is the second most common type of female reproductive cancer, and more women die from ovarian cancer than from cervical cancer and uterine cancer combined. Currently, there is no strategy for early detection of ovarian cancer that reduces ovarian cancer mortality. Taking a detailed personal and family history for breast, gynecologic, and colon cancer facilitates categorizing women based on their risk (average risk or high risk) of developing epithelial ovarian cancer. Women with a strong family history of ovarian, breast, or colon cancer may have hereditary breast and ovarian cancer syndrome (BRCA mutation) or hereditary nonpolyposis colorectal cancer (Lynch syndrome), and these women are at increased risk of developing ovarian cancer. Women with these conditions should be referred for formal genetic counseling to better assess their cancer risk, including their risk of ovarian cancer. If appropriate, these women may be offered additional testing for early detection of ovarian cancer. The use of transvaginal ultrasonography and tumor markers (such as cancer antigen 125), alone or in combination, for the early detection of ovarian cancer in average-risk women have not been proved to reduce mortality, and harms exist from invasive diagnostic testing (eg, surgery) resulting from false-positive test results. The patient and her obstetrician-gynecologist should maintain an appropriate level of suspicion when potentially relevant signs and symptoms of ovarian cancer are present.

Validation of a virtual reality simulator for the use of transvaginal ultrasonography in gynaecology and early pregnancy.

The objective was to validate a virtual reality simulation ultrasound model as a tool for training in the use of transvaginal ultrasonography in gynaecology and early pregnancy. Three separate groups consisting of novice and intermediate level residents as well as expert ultrasound examiners were recruited to the study. All were asked to answer a questionnaire regarding demographic data and ultrasound experience. They subsequently completed two modules: basic gynaecology and early pregnancy, followed by corresponding assessments using a high-fidelity simulator (Scantrainer; Medaphor™, Cardiff, UK). Finally, the expert group completed an additional questionnaire about various elements of the simulator using a 5-point Likert scale. Each group consisted of eight participants. Overall, the participants agreed that simulation played a role in training (Novices: 75% (n = 6); Intermediates: 100% (n = 8); Experts: 75% (n = 6)). For the degree of realism of the target objects in the gynaecology and early pregnancy module environments compared to a real-patient environment, the simulator was rated satisfactory or very satisfactory by 88% (n = 7) and 75% (n = 6) of experts, respectively. All experts rated the overall usefulness of the content of the simulator for learning fundamental ultrasound technical skills compared to current training methods to be at least satisfactory. When reviewing the assessment scores, experts scored higher than non-experts in gynaecology (P = 0.002) and early pregnancy modules (P = 0.03). Face, content and construct validity were demonstrated by the virtual reality ultrasound simulator, suggesting it may be an effective method for training ultrasound skills in gynaecology and early pregnancy to non-expert residents.

Clinical Analysis of Ectopic Pregnancies in a Tertiary Care Centre in Southern India: A Six-Year Retrospective Study.

Ectopic Pregnancy (EP) is a life-threatening emergency commonly encountered by medical practitioners where diagnosis can often be missed. Any woman in the reproductive age group, presenting with lower abdominal pain or vaginal bleeding must raise the suspicion of an ectopic pregnancy to prevent mortality and morbidity. To review all cases of EP and determine the incidence of EP. To study the high risk factors and know the types of clinical presentation, methods of diagnosis, outcome and complications. This was a retrospective cohort study, conducted at a tertiary care medical teaching hospital in Pondicherry, India. Medical records of all women with an EP between 2009 and 2015 were retrieved. Demographic data, parity, risk factors, clinical features, mode of management and need for blood transfusion was noted. Main outcome measures studied were the incidence of EP, risk factors, mortality and morbidity in these women. Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software version 19.0. For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean ± SD. Seventy-two EP were diagnosed during the six-year period with an incidence of 9.1/1000 pregnancies. Majority of women were aged 21-30years (51.39%), 27.8% women were nulliparous. The most common risk factors were previous abortion (36.1%) and pelvic surgery (37.50%). Fifteen cases (20.8%) were diagnosed in women who had tubectomy. The classic triad of lower abdominal pain, amenorrhoea and vaginal bleeding was seen in 29(40.3%) cases. Ultrasonography was required to arrive at a diagnosis in 28(38.9%) cases. Urine pregnancy test was positive in 100% of cases. Majority (94.4%) were tubal ectopic pregnancies. Medical management with methotrexate alone benefitted 10(13.89%) of patients while another four required surgery for failed medical management. More than half of the patients (59.7%) required blood transfusion and two (2.8%) had transfusion related acute lung injury. No deaths were noted. Common risk factors for EP must be identified. Use of transvaginal ultrasonography and human chorionic gonadotropin assay have revolutionised the management of EP and serve as valuable adjuncts to early diagnosis and management.

OP08.04: Validation of a virtual reality simulator for the use of transvaginal ultrasonography in gynecology and early pregnancy

OP08.04: Validation of a virtual reality simulator for the use of transvaginal ultrasonography in gynecology and early pregnancy

Enhancing 2D Cervical Length With 3D Cervix Imaging Emphasizing the Center Reference Point

Use of transvaginal ultrasonography for cervical length measurement at the 20-week anatomic examination has been suggested as a screening method to predict the risk of preterm birth. This article describes a three-dimensional ultrasonographic multiplanar imaging method of cervical length measurement by manipulating the center reference point and volume axes. This methodology should yield a more consistent, accurate measurement of the cervical length compared to conventional two-dimensional ultrasonographic methods. Also described are additional software image manipulation techniques to enhance visualization of the relational anatomy of the cervix. Precise utilization of the center reference point and available image reconstruction software augment current two-dimensional morphologic information of the lower genital tract.

Role of transvaginal sonography in the detection of endometrial carcinoma.

Transvagival sonography is superior to transabdominal sonography in most cases of pelvic pathology. Objective of this study is to evaluate the clinical usefulness of transvaginal ultrasonography (TVS) in pre, peri and post menopausal women suspected to have endometrial carcinoma. This cross sectional study was done with 40 patients who are clinically suspected having thickened endometrium. The study was carried out January 2007 to November 2008 for a period of two years. The patients having endometrial carcinoma diagnosed by TVS was correlated with histopathological diagnosis following collection of the report from the respective cases. Of total 40 cases, 2 (5.0%) cases were endometrial carcinoma and 38 (95.0%) were negative for endometrial carcinoma respectively in TVS findings. On the other hand 3 (7.5%) cases were endometrial carcinoma and 37 (92.5%) cases were negative for endometrial carcinoma in histopathological findings. The validity of TVS in diagnosis of endometrial carcinoma were studied by calculating sensitivity, specificity, accuracy, positive predictive value and negative predictive value, which were 67 percent, 100 percent, 98 percent, 100 percent and 97 percent respectively. As the TVS findings of the present study correlated well with the histopathology findings and the validity test values were higher than observed by others, it can be concluded that TVS is sensitive and accurate modality in the evaluation of endometrial carcinoma.

Ultrasound Diagnosis of Adenomyosis, Leiomyoma or Combined with Histopathological Correlation

Objective: To evaluate the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the diagnosis of adenomyosis, leiomyoma, or combined adenomyosis and leiomyoma by the use of transvaginal ultrasonography (TVS) compared to the histopathological findings. Subjects and Methods: This is a retrospective study of patients with a preoperative TVS diagnosis of adenomyosis, leiomyoma, or combined. Patients diagnosed with adenomyosis or combined adenomyosis and leiomyoma via TVS underwent hysterectomy. Symptomatic patients diagnosed with adenomyosis and leiomyoma via TVS underwent myomectomy with excision of the surrounding myometrium which contained possible adenomyosis. Following surgery, a histopathological examination was performed by the hospital pathologists. The microscopic diagnosis of the specimen was recorded. Results: TVS diagnosis of adenomyosis was sensitive but not specific. TVS was sensitive, specific, and accurate in the diagnosis of leiomyoma and combined adenomyosis and leiomyoma. Conclusion: This study demonstrated that TVS is a valuable noninvasive method that should be utilized in the diagnosis of leiomyoma and combined adenomyosis and leiomyoma. TVS is sensitive, but is not specific in the diagnosis of adenomyosis only.

Men perceive their female partners, and themselves, as more attractive around ovulation

The purpose of this study was to test whether men perceive changes in their female partner's attractiveness as a function of her fertility status. We further tested how both male and female self-perception varies in relation to female fertility status. This study benefits from the use of transvaginal ultrasonography to detect fertility during the regular cycle and the use of a within-subjects design in which romantic couples were followed both across the cycle and during hormonal contraceptive use. We find that men rated their female partner as more attractive near to ovulation (when fertile) as compared to during the luteal cycle phase or during hormonal contraceptive use. Moreover, our results point to a presently unrecognized negative consequence of hormonal contraceptive use on male self-perception, with men rating themselves lower in attractiveness when their partner was using hormonal contraceptives than when she was regularly cycling. In contrast, there was no difference across measures in female self-reported attractiveness. Results are discussed in terms of their potential impact on within-couple social dynamics.

Ultrasound diagnosis of adenomyosis, leiomyoma, or combined with histopathological correlation

OBJECTIVE:To evaluate the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the diagnosis of adenomyosis, leiomyoma, or combined adenomyosis and leiomyoma by the use of transvaginal ultrasonography (TVS) compared to the histopathological findings.SUBJECTS AND METHODS:This is a retrospective study of patients with a preoperative TVS diagnosis of adenomyosis, leiomyoma, or combined. Patients diagnosed with adenomyosis or combined adenomyosis and leiomyoma via TVS underwent hysterectomy. Symptomatic patients diagnosed with adenomyosis and leiomyoma via TVS underwent myomectomy with excision of the surrounding myometrium which contained possible adenomyosis. Following surgery, a histopathological examination was performed by the hospital pathologists. The microscopic diagnosis of the specimen was recorded.RESULTS:TVS diagnosis of adenomyosis was sensitive but not specific. TVS was sensitive, specific, and accurate in the diagnosis of leiomyoma and combined adenomyosis and leiomyoma.CONCLUSION:This study demonstrated that TVS is a valuable noninvasive method that should be utilized in the diagnosis of leiomyoma and combined adenomyosis and leiomyoma. TVS is sensitive, but is not specific in the diagnosis of adenomyosis only.

The accuracy of transvaginal ultrasonography for early pregnancy diagnosis in Saanen goats: A pilot study

Data on the use of transvaginal ultrasonography for pregnancy diagnosis in goats are scarce. The transabdominal and transrectal routes have been repeatedly investigated. The aim of this study was to evaluate the accuracy of real-time transvaginal ultrasound for early pregnancy diagnosis in 50 multiparous Saanen dairy goats. Following estrous synchronization and mating, a B-mode real-time scanner with a 5–7.5MHz multi-frequency endocavitary probe was used to examine the animals, in a standing position. The value of visualizing at least one gestational sac (with or without any fetal pole) to predict the birth of at least one live kid was monitored at 3–8 weeks post mating. The accuracy (proportion of true positives and true negatives to the overall study population) for predicting a live birth increased gradually from 65% at week 3, to 93% at week 8 post mating. Sensitivity values followed a similar pattern (61% at week 3, increasing to 100% at week 8). Positive and negative predictions at week 8 were 90% and 100%, respectively. However, the relationship between the observed number of fetal sacs and the actual number of live births was only 17% at week 3, increasing to about 60% at week 8. In conclusion, transvaginal ultrasound during early pregnancy in Saanen goats (especially 5–6 weeks post mating) can effectively predict live births, but not multiple pregnancies. Further investigations comparing the use of transrectal and transvaginal routes in pregnant goats should be encouraged.

The Role of Ultrasound Imaging in Detecting Endometrial Cancer in Postmenopausal Women with Vaginal Bleeding

Approximately 10% of women with postmenopausal bleeding have endometrial cancer, the most common reproductive organ malignancy among women in the United States. The use of transvaginal ultrasonography allows the clinician to identify women at risk for endometrial cancer and triage them to an appropriate procedure for a histologically confirmed diagnosis.

Modern Evaluation of the Endometrium

Abnormal uterine bleeding in women older than age 35 years, and certainly in menopausal patients, mandates evaluation, mainly to exclude cancer and hyperplasia, but also to better diagnose the source of the bleeding to appropriately manage the patient. In the past, dilation and curettage was the mainstay of diagnosis. This gave way to in-office suction pump-generated biopsies. Most recently, disposable biopsy instruments with their own internal piston to generate suction have become the standard of care. Rarely has such a technique received such widespread acceptance with such limited validation. Transvaginal ultrasonography, when technically feasible, is a noninvasive way to image the endometrial cavity. Saline-infusion sonohysterography is a subset of transvaginal ultrasonography reserved for patients in whom an adequate endometrial echo is not seen or when an endometrial echo is seen but not sufficiently thin. Appropriate understanding and use of transvaginal ultrasonography and addition of sonohysterography when necessary can allow a clinical algorithm that can triage patients with abnormal uterine bleeding to 1) no anatomic pathology best treated expectantly; 2) a global endometrial process, in which case random blind endometrial sampling is appropriate; or 3) a focal endometrial abnormality in which case endometrial sampling should be done with the visualization offered by hysteroscopy. Finally, the incidence of thick endometrial echo found incidentally in postmenopausal women with no bleeding is extremely high (10-17%) and should not trigger invasive endometrial sampling automatically.

OC21.02: Adnexal masses difficult to classify as benign or malignant using subjective evaluation of ultrasound findings: logistic regression models do not help

Objective: To compare the diagnostic value of the simultaneous evaluation of osteopontin (OPN), insulin-growth factor II (IGF II), leptin, prolactin with the use of transvaginal ultrasonography and CA 125 determination for detection of ovarian cancer. Material and methods: Eighty-three patients with an adnexal mass were included in this study and underwent sonography and ELISA assays of the four serum protein markers before surgery, associated also with the determination of CA125. For the evaluation of diagnostic performance of bio-markers we also used split-point analysis to produce a score-based classification method in which a score of 1 or below is required for benign mass, whereas a score of 2 or above indicates cancer. Results: Ten patients with ovarian cancer and 73 patients with benign ovarian neoplasm were included in the study. The median concentrations of OPN, IGF II, leptin and prolactin were not significantly different in the two groups of patients. With receiver operating characteristic curve analysis, the area under the curve was respectively 0.384 for OPN, 0.395 for IGF II, 0.570 for leptin, 0.453 for prolactin and 0.838 for CA125. Using split-point scoring methods, the simultaneous evaluation of the four new serum markers had sensitivity of 80% and specificity of 10%. With the use of only CA125 a sensitivity of 68% and specificity of 40% were obtained. The ultrasonography showed a sensitivity of 80% but a specificity of 92%. Conclusions: Although previously proposed with encouraging results in the screening of ovarian cancer, the simultaneous evaluation of these new biomarkers not seems to be useful in the preoperative evaluation of patients with an adnexal mass when compared with CA125 and transvaginal ultrasonography. This study was supported by Assessorato Igiene e Sanita, Regione Autonoma della Sardegna.