Comparative retrospective study on transvaginal sonography versus office hysteroscopy in the diagnosis of endometrial pathology among different subgroups

Abstract

Background Transvaginal sonography (TVS) and office hysteroscopy are considered essential diagnostic tool for the gynecologic everyday practice. Through the years equipment developments in both techniques along with cumulative experience gained by the gynecologists result in a disunity among clinicians in choosing optimal diagnostic approach with regards to endometrial pathology. Aim To evaluate the diagnostic accuracy of TVS versus office hysteroscopy (OHSC) in detecting endometrial pathology. Results were compared to available scientific evidence available among similar published studies. Methods Comparative Retrospective study performed at the Endoscopic Unit, Department of Gynecology, University Hospital of Ioannina, Greece. A total of 2675 cases were collected for this study from January 1997 until August 2019. All cases recruited underwent a TVS followed by office hysteroscopy (OHSC) for various indications according to the local protocol. Endometrial samples from all cases were obtained and histology confirmed the diagnosis. Sonographic and hysteroscopic results were correlated with histologic reports to assess the diagnostic accuracy of both techniques. Results In a total of 2675 cases recruited for this study, 23.2% were postmenopausal while the majority (76.7%) was of reproductive age. The commonest indication for hysteroscopy was abnormal uterine bleeding (AUB) accounting for 29.7% of the cases. Overall, TVS demonstrated diagnostic accuracy of 84.7%% in detecting endometrial pathology, compared to 97.3% of OHSC. Sensitivity, specificity, positive prognostic value (PPV) and negative prognostic value (NPV) of TVS detecting endometrial pathology were 84.0, 86.8, 95.3 and 63.0%, respectively. The corresponding values for hysteroscopy were 98.9, 95.1, 98.4 and 93.9%, respectively. Diagnostic value of both techniques was estimated in 6 (six) additional subgroups: total sample with AUB, women of reproductive age, women of reproductive age with AUB, women of reproductive age with infertility issues, postmenopausal women and postmenopausal women suffering from postmenopausal bleeding (PMB). All values were calculated with regards to histologic findings as gold standard technique. All results were correlated with scientific evidence collected from the international literature. Conclusion Office hysteroscopy is a more reliable tool in detecting endometrial pathologies compared to TVS regardless of reproductive status or clinical presentation. TVS is likely to orientate and guide specialists on what to expect prior to an hysteroscopic intervention.

Comparative study between diagnostic value of 3D ultrasound versus hysteroscopic finding in patients with perimenopausal bleeding

“…Furthermore, Gowri and Nair10 found that TVS had 67.1 percent sensitivity, 72.2 percent specificity, 91.1 percent positive predictive value, and 34.2 percent negative predictive value in detecting endometrial pathology, whereas hysteroscopy had 85.5 percent, 77.8%, 94.2 percent, and 56 percent sensitivity, specificity, positive predictive value, and negative predictive value in detecting endometrial pathology, respectively. Furthermore, our results were in line with Tsonis et al 9 as they reported that The TVS sensitivity, specificity, positive prognosis value (PPV), and negative prognostic value (NPV) for identifying endometrial disease were 84.0, 86.8, 95.3, and 63.0%, respectively. Hysteroscopy had equivalent results of 98.9, 95.1, 98.4, and 93.9 percent, respectively.…”

“…As well, Tsonis et al 9 The goal of this research was to see how well TVS compared to office hysteroscopy (OHSC) in detecting endometrial abnormalities. A total of 2675 patients were included in the research.…”

Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology

“…69 In particular, hysteroscopes less than 5 mm in diameter appear to cause the least discomfort and maintain high diagnostic sensitivity. 70–72 A randomized controlled trial of 362 postmenopausal patients showed that use of a 3.5-mm hysteroscope was associated with reduced pain compared with a 5-mm hysteroscope coupled with paracervical injection of local anesthetic. 70 Diagnostic hysteroscopy performed with a narrow-caliber hysteroscope may not require adjuvant pain control for all patients.…”

Management of recurrent miscarriages: an overview of current evidence

“…The exact prevalence of this condition though remains unclear. Magnetic Resonance Imaging remains the gold standard diagnostic technique [54], whereas Transvaginal Sonography (TVS) and Office hysteroscopy (OHSC) are cost-effective and widely available diagnostic options [55]. Sonohysterography (SHG), three dimensional ultrasonography and hysterosalpingography (HSG) are also available in some institutions providing additional diagnostic value [56,57].…”