Accuracy of Doppler assessment of the uterine arteries in healthy girls for the diagnosis of pubertal onset

Abstract

Purpose: To evaluate the accuracy of the uterine artery pulsatility index (PI) for the diagnosis of pubertal onset in girls.Methods: Cross-sectional study of girls with normal pubertal development. Puberty was diagnosed by the presence of Tanner breast development score ≥2. All girls underwent pelvic ultrasound and Doppler imaging of the uterine arteries. We evaluated the uterine artery PI and uterine, endometrial, and ovarian measurements. We used ROC curves with cutoffs determined by Youden index for data analysis.Results: We included 169 girls aged 5-16 years who underwent 202 pelvic ultrasound examinations. Prepubertal girls had a signi cantly higher mean PI (mean, 6.70; SD, 2.15) than girls in initial puberty (mean, 4.14; SD, 1.55) and in late puberty (mean, 2.81; SD, 1.05) (P<0.001 for all comparisons), which re ects a progressive increase in blood ow to the uterus with the progression of puberty. ROC curve analysis showed that the PI was able to identify the onset of puberty with a mean area under the curve of 0.838 (SD, 0.04) (P<0.001), and the PI cutoff point of 5.05 had a sensitivity of 77%, speci city of 85%, positive predictive value (PPV) of 92%, and accuracy of 79%. The combination of PI <5.05 plus uterine volume >3.75 cm³ had a sensitivity of 73%, speci city of 95%, PPV of 97%, and accuracy of 79% to detect initial puberty.Conclusions: The signi cant reduction in the PI during pubertal development combined with increasing uterine volume can be a valuable, highly speci c, noninvasive tool to con rm the onset of puberty.

Accuracy of Doppler Assessment of the Uterine Arteries for the Diagnosis of Pubertal Onset in Girls: A Scoping Review

“…The selected articles were published between 1996 and 2021 and included girls from ve countries (Italy, Brazil, Iran, Belgium, and Denmark). Six studies were cross-sectional in design [19][20][21][22][23][24] and four were prospective [25][26][27][28]. The ages of the participants ranged from 1.2 to 18 years.…”

“…The majority of the studies (n = 6) included girls who were referred for evaluation of pubertal disorders, mainly thelarche or pubarche before 8 years of age. Four articles selected healthy girls [19,22,24,28]. Ultrasound examination was reported to be performed by the same radiologist in seven studies [19,20,[23][24][25][26][27], four of which were highly experienced [19,20,23,27].…”

“…Four articles selected healthy girls [19,22,24,28]. Ultrasound examination was reported to be performed by the same radiologist in seven studies [19,20,[23][24][25][26][27], four of which were highly experienced [19,20,23,27]. The main characteristics of the studies are shown in Table 1.…”

“…Due to the well-recognized distinct ethnic and socioeconomic in uences on pubertal development, it is important to investigate the accuracy of Doppler ultrasound in each population. In studies that included healthy girls, the mean age of girls with a Tanner breast score of 2 was 9.7 years in the Danish study [24], that of initial puberty was 10.8 in the Iranian study [22], that of girls in physiological puberty was 10.5 years in the most recent Italian study [20], and that of thelarche was 10.2 years in the Brazilian study [19].…”

“…Furthermore, the ultrasound examination is operator-dependent, and its outcome can be in uenced by the experience of the radiologist. Four studies mention that an experienced radiologist performed the examinations, and in only two articles were the intra-or interobserver variability of the PI measures assessed [19,20]. Finally, the cutoff point is generally given by the optimal cut-point when equal weight is given to sensitivity and speci city [34].…”