Two‐dimensional transvaginal sonography <i>vs</i> saline contrast sonohysterography for diagnosing endometrial polyps: systematic review and meta‐analysis

Sanín-Ramírez, Daniel; Carriles, Isabel; Graupera, B.; Ajossa, Silvia; Neri, Manuela; Rodríguez, I.; Pascual, M.; Guerriero, S.; Alcázar, Juan Luis

doi:10.1002/uog.22161

Cited by 7 publications

(5 citation statements)

References 51 publications

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“…Our results validated the existence of RE and the high accuracy of TVUS, SIS, and hysteroscopy, for the identification of EP, confirming previous studies 14 . In our study, hysteroscopy showed a high sensitivity, however, not the highest sensitivity among the three diagnostic modalities, as reported by other studies 15, 16 .…”

Section: Discussionsupporting

confidence: 92%

“…Our results validated the existence of RE and the high accuracy of TVUS, SIS, and hysteroscopy, for the identification of EP, confirming previous studies. 14 In our study, hysteroscopy showed a high sensitivity, however, not the highest sensitivity among the three diagnostic modalities, as reported by other studies. 15,16 When the two endometrial abnormalities, RE and EP, were combined, the three diagnostic modalities showed high sensitivity and NPV, with SIS having the highest, but lower specificity and PPV.…”

Section: Discussionsupporting

confidence: 85%

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Endometrial Abnormalities

Detti

Christiansen

Peregrín-Álvarez

2021

J of Ultrasound Medicine

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Objectives We sought to evaluate the diagnostic accuracy of transvaginal ultrasound (TVUS) saline infusion sonohysterogram (SIS), and hysteroscopy for diagnosing endometrial abnormalities and their correlation with histological findings. In addition, we sought to validate the subsistence of a more subtle abnormality called “redundant endometrium” (RE). Methods Retrospective cohort study of patients presenting with infertility and diagnosed with endometrial abnormalities who underwent hysteroscopy and pathology evaluation. Each patient underwent TVUS at the first visit regardless of the cycle phase, followed by SIS during proliferative phase, and then hysteroscopy, which was performed when abnormal SIS findings were diagnosed. Endometrial abnormalities were categorized as polyps (EP), RE, or normal. Frequencies of the abnormalities were recorded for the 3 imaging modalities and their sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each. Results A total of 105 TVUS and 73 SIS were performed. Because of the frequent association of EP with RE, when all endometrial pathologies were combined, the three diagnostic modalities showed high sensitivity (TVUS 88.9%, SIS 100%, hysteroscopy 82.9%, respectively), but they also showed low specificity (TVUS 56.7%, SIS 56.1%, hysteroscopy 58.2%, respectively). Pathological evaluation showed isolated RE (26 cases), to harbor polyps (19.2%), disordered endometrium (19.2%), and complex atypical hyperplasia (3.8%). Conclusions The three diagnostic modalities showed high sensitivity in diagnosing endometrial abnormalities. We identified RE as an independent endometrial abnormality. Benign endometrium is the predominant histology in RE, however, a small proportion harbors endometrial hyperplasia. Based on these results, we advocate further evaluation when this condition is diagnosed with TVUS, or SIS.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 85%

Endometrial Abnormalities

Detti

Christiansen

Peregrín-Álvarez

2021

J of Ultrasound Medicine

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“…Saline infusion sonohysterography paired with hysterosalpingo-contrast sonography can accomplish both goals in experienced hands (46)(47)(48)(49). Given its excellent diagnostic accuracy and tolerability, saline infusion sonography has emerged as the initial method of choice for evaluating the uterine cavity (50)(51)(52)(53)(54). Of note, randomized clinical trial (RCT) data indicate that the routine use of diagnostic hysteroscopy either before the initial ET or after multiple ETs does not improve the odds of sustained IRs (55,56).…”

Section: Uterine Factorsmentioning

confidence: 99%

Recurrent Implantation Failure: Reality or a Statistical Mirage?: Consensus Statement From the July 1, 2022 Lugano Workshop on Recurrent Implantation Failure

Pirtea

Cedars

Devine

et al. 2023

Obstetrical &Amp; Gynecological Survey

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Despite advancements in assisted reproductive technologies over the past few decades, a 35% failure rate is still observed for unexplained reasons when transferring euploid embryos to an anatomically normal uterus. Recurrent implantation failure (RIF) is defined based on cumulative ART cycles failing; however, there is an absence in consensus on the diagnostic criteria, which leads to the risk of overdiagnosing and overtreating the condition. This consensus statement by the Lugano RIF Workshop aimed to merge variation in the clinical concept and management of RIF, focusing primarily on euploid blastocyst transfers in hormone replacement-primed cycles. The workshop comprised a panel of 27 international experts selected on the basis of overall research activities and publications on the subject. A literature search as conducted for all relevant titles and abstracts published between January 2015 and May 2022 for review. Consensus conclusions were based on the literature search and expert opinions. Consideration of an RIF diagnosis was determined to focus on failure to achieve sustained implantation (defined as a gestational sac identified on ultrasound). Historically, RIF was defined as the failed transfer of >10 embryos; however, today, a common number used is 3, which is also similar to the rate of failure based on a 95% confidence interval. Based on large clinical data sets, approximately 2%–5% of patients pursuing ART treatment may have RIF, and the decline in future implantation rate with each cycle fits more to an exponential delay curve than a linear decrease. The diagnosis of RIF should not be considered based on a single cohort of embryos, but rather on the number of euploid blastocyst transferred adjusted to patient’s age. In the absence of abnormal uterine bleeding and normal uterine size, further evaluation of asymptomatic adenomyosis is not warranted. Testing for biomarkers of endometrial receptivity and the endometrial microbiome have not been validated using RCTs and should not be used. The role of chronic inflammation in RIF remains unclear, but evidence suggests chronic endometritis does not directly play a role in ART outcome as assessed by sustained implantation rate after euploid embryo transfer. Substantial evidence exists that is low progesterone on the day of embryo transfer results in worse ART outcomes, and that IM progesterone may be superior to vaginal progesterone. There are no effective treatments for RIF currently, and immunomodulatory treatments that may be offered including glucocorticoids, IVIG, and GCSF have a lack of comprehensive data. This consensus document finds that RIF is likely present in fewer than 5% of patients undergoing ART and has been overdiagnosed and overtreated without sufficient critical evaluation of the presumed condition. It also highlights areas where future research is needed, both in the pathophysiologic cause of RIF and hypothetical treatment modalities.

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“…Compared to hysteroscopy, transvaginal ultrasound (TVUS) technology is noninvasive, inexpensive and widely used; therefore, it has become an initial screening tool for the evaluation of endometrial diseases. However, as the efficiency of TVUS depends heavily on the experience of its clinician handlers, its sensitivity and specificity for diagnosing EP are only 55.0% and 91.0%, respectively, which are highly heterogeneous 14,15 . According to reports, based on the TVUS diagnosis of women with AUB and comparison with the final postoperative pathological biopsy results, 6.25% to 12.5% of patients with EP were misdiagnosed to have EC, while 42.31% were misdiagnosed to have EH, which significantly affects the choice of hormonal drugs and the scope of surgical treatment 16,17 …”

Section: Introductionmentioning

confidence: 99%

“…However, as the efficiency of TVUS depends heavily on the experience of its clinician handlers, its sensitivity and specificity for diagnosing EP are only 55.0% and 91.0%, respectively, which are highly heterogeneous. 14,15 According to reports, based on the TVUS diagnosis of women with AUB and comparison with the final postoperative pathological biopsy results, 6.25% to 12.5% of patients with EP were misdiagnosed to have EC, while 42.31% were misdiagnosed to have EH, which significantly affects the choice of hormonal drugs and the scope of surgical treatment. 16,17 In contrast, serum is an ideal sample type for the rapid diagnosis of clinical diseases.…”

Section: Introductionmentioning

confidence: 99%

A serum lipidomics study for the identification of specific biomarkers for endometrial polyps to distinguish them from endometrial cancer or hyperplasia

Yan

Zhao

Wei

et al. 2022

Intl Journal of Cancer

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Endometrial diseases, including endometrial polyps (EP), endometrial cancer (EC) and endometrial hyperplasia (EH), are common gynecological diseases that affect women of childbearing and perimenopausal age. Clinically, biopsy or imaging methods are usually used to screen and diagnose these diseases; however, due to the invasiveness and heterogeneity of these tests, a noninvasive, convenient, objective and accurate biomarker is needed for the differential diagnosis of EP, EC or EH. In the present study, serum samples from 326 patients with endometrial diseases and 225 healthy volunteers were analyzed using nontargeted lipidomics. A combination of multivariate and univariate analyses was used to identify and qualify six, eight and seven potential biomarkers in the sera from patients with EP, EC and EH, respectively. Using a logistic regression algorithm and receiver operating characteristic (ROC) curve analysis, a biomarker panel including four specific EP biomarkers, 6‐keto‐PGF1α, PA(37:4), LysoPC(20:1) and PS(36:0), showed good classification and diagnostic ability in distinguishing EP from EC or EH. The biomarker panel for distinguishing EP from EC yielded an area under the curve (AUC) of 0.915, sensitivity of 100% and specificity of 72.41%, while that for distinguishing EP from EH yielded an AUC of 1.000, sensitivity of 100% and specificity of 100%. The two diagnostic models also showed good diagnostic abilities in the validation set. Therefore, this biomarker panel can be used as a rapid diagnostic method to assist in imaging examinations and provide a reference for clinicians in the identification and diagnosis of endometrial diseases.

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Two‐dimensional transvaginal sonography vs saline contrast sonohysterography for diagnosing endometrial polyps: systematic review and meta‐analysis

Cited by 7 publications

References 51 publications

Endometrial Abnormalities

Endometrial Abnormalities

Recurrent Implantation Failure: Reality or a Statistical Mirage?: Consensus Statement From the July 1, 2022 Lugano Workshop on Recurrent Implantation Failure

A serum lipidomics study for the identification of specific biomarkers for endometrial polyps to distinguish them from endometrial cancer or hyperplasia

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