Accuracy of Transvaginal Ultrasonography, Hysteroscopy and Uterine Curettage in Evaluating Endometrial Pathologies

Abstract

To evaluate the accuracy of transvaginal ultrasonography, hysteroscopy and uterine curettage in the diagnosis of endometrial polyp, submucous myoma and endometrial hyperplasia, using as gold standard the histopathological analysis of biopsy samples obtained during hysteroscopy or uterine curettage. Cross-sectional study performed at the Hospital Universitário de Brasília (HUB). Data were obtained from the charts of patients submitted to hysteroscopy or uterine curettage in the period from July 2007 to July 2012. One-hundred and ninety-one patients were evaluated, 134 of whom underwent hysteroscopy, and 57, uterine curettage. Hysteroscopy revealed a diagnostic accuracy higher than 90% for all the diseases evaluated, while transvaginal ultrasonography showed an accuracy of 65.9% for polyps, 78.1% for myoma and 63.2% for endometrial hyperplasia. Within the 57 patients submitted to uterine curettage, there was an accuracy of 56% for polyps and 54.6% for endometrial hyperplasia. Ideally, after initial investigation with transvaginal ultrasonography, guided biopsy of the lesion should be performed by hysteroscopy, whenever necessary, in order to improve the diagnostic accuracy and subsequent clinical management.

Comparison of endometrial assessment by transvaginal ultrasonography and hysteroscopy

“…A limitation of ultrasonography imaging is that it does not allow biopsy for diagnostic confirmation. In view of this, a recent study concluded that ultrasonography presents a barrier to the diagnosis of endometrial pathologies and that a biopsy should be performed under direct visualization by hysteroscopy …”

Comparison of ultrasound with hysteroscopic and histological findings for intrauterine assessment

“…Polyps were confirmed in up to 28% of symptomatic postmenopausal women 2 . In 134 patients who underwent hysteroscopy, the procedure revealed a diagnostic accuracy higher than 90% for all the diseases evaluated, while transvaginal ultrasonography showed an accuracy of 65.9% for polyps 10 . Higher sensitivty up to 89% and specificity up to 87% is obtained when using color-flow sonography and detecting one feeding blood vessel 11 .…”

“…This study comprised 789 premenopausal women and had 94% sensitivity and 95% specificity of hysteroscopical procedure, while transvaginal ultrasound had sensitivity 54% and specificity 80% for detection endometrial polyps 12 . Ideally, after initial investigation with transvaginal ultrasonography, guided biopsy of the lesion should be performed by hysteroscopy, whenever necessary, in order to improve the diagnostic accuracy and subsequent clinical management 10 . There is a chance for spontaneous regression of polyps, higher for smaller ones 13 .…”

A Comparative Observational Study of the Use Transvaginal Ultrasound and Hysteroscopy for the Detection of Uterine Cavity Pathologies in Women with Abnormal Uterine Bleeding

“…They recommended that after initial investigation with transvaginal ultrasonography, guided biopsy of the lesion should be performed by hysteroscopy when-ever necessary in order to improve the diagnostic accuracy and subsequent clinical management [17].…”