Accuracy of Transvaginal Ultrasound in the Diagnosis of Intrauterine Lesions

Abstract

Objective To evaluate the accuracy of transvaginal ultrasound in the diagnosis of intrauterine lesions, using hysteroscopy as the gold standard. Methods This was a prospective observational study with 307 patients. All patients underwent hysteroscopy after a previous transvaginal ultrasound to compare the results. The hysteroscopy was performed by experienced examiners, and transvaginal ultrasounds were performed in various public and private services, which is reflective of routine healthcare practices in obstetrics and gynecology. The sensitivity, specificity, and accuracy of the transvaginal ultrasound were calculated using hysteroscopy as the gold standard. The level of agreement between the two exams was calculated using the Kappa test. Results The mean age was 56.55 ± 12.3 years. For endometrial polyps, we observed a sensitivity of 39.8%, specificity of 72.7%, accuracy of 52.8%, and Kappa index of 0.11 (p = 0.025). For fibroids, the sensitivity was 46.7%, specificity was 95.0%, accuracy was 87.9%, and Kappa index was 0.46 (p < 0.001). For endometrial thickening, the sensitivity was 68.7%, specificity was 41.7%, accuracy was 47.6%, and Kappa index was 0.06 (p = 0.126). For endometrial atrophy, we found a sensitivity of 6.7%, specificity of 99.3%, accuracy of 90.2%, and Kappa index of 0.10 (p = 0.006). For the other findings, the sensitivity was 15.6%, specificity was 99.6%, accuracy was 87.3%, and Kappa index was 0.23 (P < 0.001). Conclusion Our study demonstrated a low level of accuracy of transvaginal ultrasound for the diagnosis of endometrial lesions, when performed by a non-experienced professional. Thus, it is important to consider the use of hysteroscopy to avoid unnecessary and inappropriate treatments.

Reporting of uterine fibroids on ultrasound examinations: an illustrated report template focused on surgical planning

“…The treatment of patients with uterine fibroids should be individualized on the basis of the symptoms, patient age, patient desire to preserve fertility or the uterus, and the characteristics of the nodules (e.g., size and location), as well as the availability of therapy and the experience of the attending physician ( 2 , 3 ) . In this context, ultrasound is considered the initial test of choice for the diagnosis of fibroids in symptomatic patients, mainly due to its broad availability, ease of use, cost-effectiveness, high sensitivity, and high specificity ( 4 , 5 ) . The examination should be performed by specially trained physicians, with the aim of accurately identifying and describing all fibroids ( 4 , 5 ) .…”

“…In this context, ultrasound is considered the initial test of choice for the diagnosis of fibroids in symptomatic patients, mainly due to its broad availability, ease of use, cost-effectiveness, high sensitivity, and high specificity ( 4 , 5 ) . The examination should be performed by specially trained physicians, with the aim of accurately identifying and describing all fibroids ( 4 , 5 ) . Other aspects that are crucial in the choice of treatment—the size and location of fibroids; the presence and size of the submucosal component; penetration of the myometrial component; proximity to the uterine serosa; relationship with and proximity to the endometrial cavity; vascular supply; and coexistence of adenomyosis or deep endometriosis—are easily determined and can be characterized by using transvaginal ultrasound ( 5 , 6 , 7 ) .…”

Avaliação da prevalência de istmocele em pacientes com cesariana prévia submetidas ao exame de histeroscopia ambulatorial

“…No entanto, não se sabe a prevalência exata dessa afecção, uma vez que varia de acordo com o método utilizado para avaliação 3,4,10 . Ao exame de ultrassonografia transvaginal, a prevalência se estabelece entre 24% e 70% e à histeroscopia, exame padrão-ouro para diagnóstico, esses valores aumentam para 56% a 84% em mulheres com uma ou mais cesáreas prévias 1,11 .…”

Diagnostic Value of Ultrasonography Combined with Hysteroscopy in Intrauterine Space‐Occupying Abnormalities

“…Transvaginal ultrasound combined with sonohysterography (SHG) is to place contrast agent (generally without bacterial saline) through the cervix into the uterine cavity, manually dilate the uterine cavity, and then separate the endometrium, and transvaginal sonography (TVS) should be performed to timely monitor the endometrial condition and intrauterine problems [ 1 ]. SHG has been a commonly used clinical diagnostic method in recent years and belongs to the method of noninvasively detecting intrauterine lesions, which enhances the diagnostic sensitivity and specificity of endometrial diseases [ 2 ]. Studies have confirmed that SHG has a high clinical value for this disease when patients present with diffuse or focal intrauterine lesions [ 3 ].…”