Comparison of transvaginal sonography, saline infusion sonography, and hysteroscopy in premenopausal women with abnormal uterine bleeding

Vries, Laila D. de; Dijkhuizen, F. P. H. L. J.; Mol, Ben Willem J.; Brölmann, Hans A.M.; Moret, Eveline; Heintz, A. Peter M.

doi:10.1002/(sici)1097-0096(200006)28:5<217::aid-jcu2>3.3.co;2-2

Cited by 14 publications

(23 citation statements)

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“…The technique of instilling saline into the uterus during TVS (transvaginal saline hysterosonography, TVHSg) can enhance its diagnostic accuracy. Studies in post-menopausal women have compared TVHSg to hysteroscopy, showing it to be comparable in detecting benign lesions [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Transvaginal saline hysterosonography: a comparison with local anaesthetic hysteroscopy for the diagnosis of benign lesions associated with menorrhagia

Georgantopoulou¹,

Simm

Roberts

2007

Gynecol Surg

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The objective of this paper is to assess the diagnostic accuracy of transvaginal saline hysterosonography (TVHSg) compared to hysteroscopy in the identification of benign lesions affecting the endometrium in women with menorrhagia. A cross-sectional study was reported according to the Standards for Reporting of Diagnostic Accuracy (STARD) guidelines. These standards were introduced by an international steering committee in order to improve the reporting of diagnostic accuracy studies. The study was carried out at a one-stop menorrhagia clinic at a central teaching hospital in Newcastle Upon Tyne, UK. One hundred and forty patients were referred to the menorrhagia clinic. After clarification of their history, TVHSg was performed on each patient and the findings were recorded on a proforma. The patients then underwent hysteroscopy using local anaesthetic and a Pipelle endometrial biopsy was performed. Each operator was blinded to the findings of the preceding investigation until both proformas had been completed. The diagnostic accuracy of TVHSg was compared to hysteroscopy in the diagnosis of benign intrauterine lesions. TVHSg has a sensitivity of 0.88, a specificity of 0.99, a positive predictive value of 0.96, a negative predictive value of 0.97 and a positive likelihood ratio of 99 in the detection of endometrial polyps. For the detection of submucous fibroids, the sensitivity is 0.86, the specificity is 0.98, the positive predictive value is 0.90, the negative predictive value is 0.97 and the positive likelihood ratio is 49. We conclude that TVHSg has high diagnostic accuracy for the detection of intracavitary lesions in patients with menorrhagia when compared to out-patient hysteroscopy.

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Section: Introductionmentioning

confidence: 99%

Transvaginal saline hysterosonography: a comparison with local anaesthetic hysteroscopy for the diagnosis of benign lesions associated with menorrhagia

Georgantopoulou¹,

Simm

Roberts

2007

Gynecol Surg

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“…[1][2][3][4] Submucosal leiomyomata or polyps are found in approximately 50% of premenopausal women referred for ultrasound evaluation of abnormal uterine bleeding. 1,[5][6][7] However, the prevalence of both lesions is lower in nonselected populations of perimenopausal women being evaluated for their initial complaint of abnormal bleeding. 8 These lesions are also found in asymptomatic women.…”

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confidence: 99%

Natural History of Uterine Polyps and Leiomyomata

DeWaay

Syrop

Nygaard

et al. 2002

Obstetrics & Gynecology

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OBJECTIVE:To estimate the incidence and regression rates of uterine leiomyomata and polyps in a cohort of asymptomatic, premenopausal women. METHODS:Saline infusion sonography was performed twice, 2.5 years apart, in a cohort of 64 initially asymptomatic women. Subjects completed a questionnaire that assessed the development of abnormal uterine bleeding. RESULTS:The mean age of women (at second ultrasound) was 44 years. In four of seven women with polyps at the original ultrasound, their polyps regressed. Polyps that regressed tended to be smaller than polyps that persisted. Ten women had endometrial polyps at the second ultrasound for a point prevalence of 16% and a cumulative incidence rate of 12% per 2.5 years. A higher percentage of women with uterine polyps had complaints of abnormal uterine bleeding than women with no uterine abnormalities (70% versus 33%, P ‫؍‬ .04). Six leiomyomata in four women were no longer detected in the second ultrasound. Leiomyomata that regressed were in older premenopausal women and were smaller than leiomyomata that persisted. The point prevalence and incidence rates of leiomyomata were 27% and 13% per 2.5 years, respectively. Leiomyomata grew an average of 1.2 cm per 2.5 years, but great variation in growth rates were noted. CONCLUSION:Small uterine polyps frequently regressed spontaneously, whereas larger polyps were more likely to persist and were associated with the development of abnormal bleeding. Smaller leiomyomata in older premenopausal women also regressed whereas larger leiomyomata tended to grow while often remaining asymptomatic. (Obstet Gynecol 2002;100:3-7. Benign uterine lesions, such as endometrial polyps and leiomyomata, are common in women, especially those over age 35 years. 1-4 Submucosal leiomyomata or polyps are found in approximately 50% of premenopausal women referred for ultrasound evaluation of abnormal uterine bleeding. 1,5-7 However, the prevalence of both lesions is lower in nonselected populations of perimenopausal women being evaluated for their initial complaint of abnormal bleeding. 8 These lesions are also found in asymptomatic women. 1 Endometrial polyps and leiomyomata are frequently removed surgically because of their association with abnormal uterine bleeding. 1,9 Despite the high prevalence of these conditions and the morbidity attributed to them, little is known about their natural history.In 1999, using saline infusion sonography, we compared the prevalence of benign uterine lesions in 80 women with abnormal uterine bleeding to a cohort of 100 asymptomatic premenopausal women over age 30 years. 1 We detected polyps in 10% and leiomyomata in 13% of the asymptomatic controls. In our current study, we add to the understanding of the natural history of uterine polyps and leiomyomata. By reevaluating this group of initially asymptomatic women, we aimed to estimate the incidence rate and regression rate of uterine leiomyomata and polyps, as determined by saline infusion sonography. MATERIALS AND METHODSThis study was approved by the Universit...

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“…Transvaginal ultrasound is usually the first diagnostic modality in the case of a suspected endometrial pathology, but it was reported to be insufficient to determine lesions smaller than 2 cm [1]. Some retrospective studies suggest that 22% of leiomyoma cannot be detected by ultrasound, and the uterus is reported as normal [1]. Intracavitary lesions are particularly difficult to diagnose by ultrasound, and its diagnostic accuracy is reported between 88-96% [2].…”

Section: Discussionmentioning

confidence: 99%

“…De Vries suggested equivalent diagnostic efficiency with SIS compared to Normal 53 39 13 1 0 Polyp 189 44 141 2 2 Myoma 37 11 10 16 0 Adhesion 14 10 3 1 0 Septum 5 4 1 0 0 Total 298 108 168 20 2 hysteroscopy in 72% of the patients [1]. In our series, we determined 87.2% sensitivity to detect endometrial polyps and 71.4% sensitivity for documenting submucosal leiomyoma in SIS procedures, while the respective values were 83.9 and 80.0% for the hysteroscopy procedures.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of hysteroscopy for endometrial pathology: the experience of a university clinic on diagnostic accuracy and the comparison with the other methods

et al. 2004

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Hysteroscopy procedures were retrospectively reviewed in order to reveal the diagnostic accuracy and the efficiency of the diagnostic procedures (transvaginal ultrasonography/TvUsg, saline infusion sonography/SIS, hysteroscopy) for an educational institution in the management of abnormal uterine bleeding. The study was completed in the Department of Gynecology and Obstetrics of the Istanbul University Cerrahpaşa School of Medicine by reviewing the hospital records of the patients on whom hysteroscopy had been performed between 1 January 1997 and 31 December 2002. The records of 385 patients were eligible. The sensitivity, specificity and positive and negative predictive values for saline infusion sonography and hysteroscopy were calculated for specific histopathological diagnoses. The sensitivity and specificity of hysteroscopy for the detection of endometrial polyps were calculated as 83.9 and 63.0%, respectively. The positive predictive value (PPV) was 74.6% and negative predictive value (NPV) 75.2%. The sensitivity and specificity of saline infusion sonography for the detection of endometrial polyps were found to be 87.2 and 33.3%, respectively. PPV was 71.4% and NPV was 57.6% for SIS. The sensitivity and specificity of hysteroscopy for the detection of submucosal leiomyoma were determined to be 80.0 and 92.4%, respectively. PPV was 43.2% and NPV was 98.0%. The sensitivity and specificity of SIS for the detection of submucosal leiomyoma were 71.4 and 92.3%, respectively. PPV was calculated as 52.6% and NPV as 75.2% for SIS. Due to its high diagnostic accuracy and lower complication rate even in the educational setting, we believe that hysteroscopy will retain its place as the "gold standard" procedure for the investigation of endometrial pathology.

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Comparison of transvaginal sonography, saline infusion sonography, and hysteroscopy in premenopausal women with abnormal uterine bleeding

Cited by 14 publications

References 0 publications

Transvaginal saline hysterosonography: a comparison with local anaesthetic hysteroscopy for the diagnosis of benign lesions associated with menorrhagia

Transvaginal saline hysterosonography: a comparison with local anaesthetic hysteroscopy for the diagnosis of benign lesions associated with menorrhagia

Natural History of Uterine Polyps and Leiomyomata

The efficacy of hysteroscopy for endometrial pathology: the experience of a university clinic on diagnostic accuracy and the comparison with the other methods

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