Comparison of saline infusion sonography and histological findings in the evaluation of uterine cavity pathologies

Aim  To evaluate the accuracy of saline infusion sonography for the diagnosis of endometrial cavity abnormalities in patients who presented with abnormal uterine bleeding. Methods  Eighty-three women suspected of having endometrial cavity abnormalities were evaluated using saline infusion sonography. The results of this technique were compared with the histological evaluation reports of these women either with hysteroscopy or laparotomy prospectively. Results  The positive predictive value (PPV) for endometrial polyps was 25%; the negative predictive value (NPV) was 93%; the sensitivity for endometrial polyps was 80% and the specificity was 87%. The PPV, the NPV, the sensitivity and the specificity for submucous fibroids were 65, 85, 81 and 89%, respectively. Conclusions  Saline infusion sonography was a reliable and accurate method for investigations of the endometrium and uterine cavity with good correlation, with histological results of more invasive procedures. It can be a good alternative technique for the evaluation of uterine cavity abnormalities where office hysteroscopy is not available.     

Saline infusion sonography and office hysteroscopy to assess endometrial morbidity associated with tamoxifen intake

OBJECTIVE: The objective of this study was to compare office feasibility, patient acceptance, and diagnostic accuracy of hysteroscopy (HYS) and saline infusion sonography (SIS) in breast cancer patients taking tamoxifen. METHODS: Sixty-six asymptomatic postmenopausal women on tamoxifen for breast cancer underwent SIS, followed by outpatient HYS with endometrial biopsy. In all women an endometrial stripe over 4 mm was previously measured by transvaginal ultrasonography (TU). Histologic reports were matched with sonographic and hysteroscopic findings. After SIS and HYS, patients were asked to rate pelvic pain experienced during the two procedures on a 10 cm Visual Analog Scale (VAS). RESULTS: SIS and HYS were not accomplished in 26 (39.3%) and 4 (6.0%) patients, respectively, due to cervical stenosis or patient intolerance. No adverse event was recorded after 40 SIS and 62 hysteroscopic procedures. Pathologic assessment reported 15 polyps (22.7%), 7 hyperplasias (10.5%), and 2 submucous myomas (3.0%). Sensitivity, specificity, and negative and positive predictive values of SIS in distinguishing between normal and abnormal endometrium were 85.7, 83.3, 93.7, and 66.0%, respectively, whereas HYS provided corresponding values of 100, 94.1, 97.8, and 100%, respectively. No significant difference was found between SIS and HYS in the subjective perception of pelvic pain (VAS scores 3.02 +/- 2.8 and 3.82 +/- 2.7, respectively). CONCLUSIONS: Office hysteroscopy is a safe and conclusive diagnostic tool for endometrial investigation in menopausal women on tamoxifen. It exposes the patients to the same pelvic discomfort as SIS, but has a better feasibility rate and diagnostic accuracy.     

A randomised comparison of vaginoscopic office hysteroscopy and saline infusion sonography: a patient compliance study

Objective  The purpose of this study was to compare patient discomfort during saline infusion sonography (SIS) and office hysteroscopy performed according to a vaginoscopic approach.
Design  Randomised controlled trial.
Setting  University hospital.
Population  Women with an indication for further investigation of the uterine cavity.
Methods  A total of 100 women randomly allocated to either SIS or vaginoscopic office hysteroscopy in an outpatient clinic.
Main outcome measures  Scores on a visual analogue scale (VAS) for pain and a present pain intensity (PPI) scale, conclusiveness and success rate.
Results  The patients' pain scores on both the VAS and the PPI were lower for SIS when compared with office hysteroscopy ( P < 0.05). However, in cases of severe pain (VAS > 7 or PPI > 2), there was no statistically significant difference between both groups. The success rate, defined as adequate inspection of the cervical canal and uterine cavity, was 94% for SIS compared with 92% for office hysteroscopy ( P = 0.633). SIS, multiparity, shorter procedure time and position of the uterus in anteversion decreased pain scores among women studied.
Conclusions  Both SIS and office hysteroscopy are successful procedures and well tolerated by women. SIS induces significantly less discomfort than office hysteroscopy and should therefore be considered the method of choice.     

109例绝经后出血患者B超、针吸术、分段诊刮及宫腔镜检查四种诊断方法的比较

目的　绝经后出血是一种常见的临床主诉 ,造成绝经后出血的原因可能为子宫内膜癌、内膜息肉、黏膜下肌瘤和炎症等。及时地对绝经后出血的患者进行诊断是很重要的。本研究旨在通过比较阴道B超、针吸、诊刮和宫腔镜检查对绝经后出血的诊断 ,分析其各自的优缺点。方法　本试验取 2 0 0 1年 1月～ 2 0 0 3年 8月在我院就诊的绝经后出血的患者共 1 0 9例 ,每位患者均行阴道超声检查和分段诊刮术 ,其中 31名患者在行分段诊刮前行针吸术 ,74名在诊刮的同时行宫腔镜检查。结果　阴道B超提示子宫内膜厚度≤ 4mm ,无内膜癌和增生性疾病发生。针吸给患者带来的痛苦小 ,对子宫内膜癌的检出率与分段诊刮相似 ,均为 6 6 7%。分段诊刮的病理和宫腔镜下诊断完全一致者占 71 6 2 % ,有近 30 %漏诊。宫腔镜诊断子宫内膜癌的敏感性为 1 0 0 % ,特异性为 85 71 %。分段诊刮和宫腔镜结合对子宫内膜的病变检出率最高。结论　对于绝经后出血的患者 ,可先行阴道B超 ,如超声提示内膜厚度≤ 4mm ,在没有高危因素的情况下 ,可免于分段诊刮 ,但应密切随诊。在子宫内膜厚度 >4mm无高危因素下 ,可行针吸术代替分段诊刮。如阴道B超示有异常回声或存在高危因素 ,则应行分段诊刮和 或宫腔镜检查。     

彩超、宫腔镜、病理对子宫内膜病变诊断价值的研究

目的 探讨经阴道彩超、官腔镜、病理检查对子宫内膜病变的诊断价值。方法 对60例可疑子宫内膜病变患者采用阴道彩超检查、诊断性官腔镜检查及诊刮术，与病理检查结果做对照分析。结果 60例病理确诊为功能失调性子宫出血者为49例，子宫黏膜下肌瘤为0例，子宫内膜癌为1例，子宫内膜息肉为10例。阴道彩超诊断子宫内膜增厚为49例，子宫黏膜下肌瘤为8例，子宫内膜癌为0例，子宫内膜息肉为3例。宫腔镜检查诊断功能失调性子宫出血者为43例，子宫黏膜下肌瘤为3例，子宫内膜癌为0例，子宫内膜息肉为14例。结论 经阴道彩超是筛选子宫内膜病变的方便、简捷、有效与经济的方法，宫腔镜是可靠的诊断方法，而金标准是子宫内膜病理学检查。     

Transvaginal ultrasound and diagnostic hysteroscopy as a predictor of endometrial polyps: risk factors for premalignancy and malignancy

The aim of this study is to assess accuracy of transvaginal ultrasound (TVUS) and diagnostic hysteroscopy in diagnosing endometrial polyps and to determine premalignancy and malignancy rates in asymptomatic women. The study was designed to retrospectively analyze 438 women who underwent operative hysteroscopy in a day-care unit when endometrial polyp was suspected after TVUS and diagnostic hysteroscopy. Multivariate logistic regression modeling showed effects of age, previous breast cancer with tamoxifen treatment, and menopause with or without bleeding on pathologic results. The results indicate that positive predictive value of TVUS with diagnostic hysteroscopy was 79.9%. Premalignancy or malignancy occurred in 3.2% and was significantly related to menopause with abnormal bleeding (P < 0.001), which carried a 20-fold higher risk of pathology than any other group. Age was also a risk factor. It was concluded that TVUS with diagnostic hysteroscopy reliably evaluates endometrial polyps. The low incidence of endometrial tumors in asymptomatic (especially premenopausal) women suggests that their operative evaluation may not be cost effective. Larger studies are needed to support this tentative conclusion.     

经阴道超声及宫腔超声造影诊断子宫腔内病变的价值

目的:探讨经阴道超声及宫腔超声造影诊断子宫腔内病变的价值。方法:经阴道超声及生理盐水宫腔超声造影后行阴道超声分别诊断子宫腔内病变,以病理结果为标准,判断宫腔超声造影诊断子宫腔内病变的价值。结果:87例经阴道超声、69例经阴道宫腔超声造影诊断子宫腔内病变的准确率分别为83.9%(73/87)、94.2%(65/69)。结论:经阴道宫腔超声造影是诊断子宫腔内病变的一种简便、经济、无损伤、诊断率高的方法。     

Cost-effectiveness of transvaginal sonography and saline infused sonography in the evaluation of menorrhagia.

OBJECTIVES: To assess the cost-effectiveness of transvaginal sonography (TVS) and saline infused sonography (SIS) in the diagnostic work-up of women with menorrhagia. METHODS: We performed a decision analysis in which we compared the percentage of patients treated successfully and cost of six strategies for the evaluation of menorrhagia: (0) hormonal treatment, (I) treatment of all patients with balloon ablation, (II) TVS and therapeutic hysteroscopy, (III) TVS, SIS and therapeutic hysteroscopy, (IV) SIS and therapeutic hysteroscopy, and (V) diagnostic hysteroscopy and therapeutic hysteroscopy. Hormonal treatment was considered to be the reference strategy to which the five strategies were compared. Data were obtained from the published literature. In order to evaluate the robustness of our results, we performed extensive sensitivity analyses, in which we varied sensitivity and specificity of TVS and hysteroscopy, the prevalence of intracavitary abnormalities, as well as costs of TVS and SIS. RESULTS: We found that the strategy starting with SIS (IV) and the strategy with diagnostic hysteroscopy (V) revealed the highest number of patients treated successfully for menorrhagia. In terms of cost-effectiveness, SIS for all patients was superior over immediate diagnostic hysteroscopy for all patients. Strategies starting with TVS were less effective than the strategy starting with SIS. CONCLUSIONS: We recommend SIS as the procedure of first choice in the work-up for women with menorrhagia.     

Comparison of diagnostic accuracy of saline infusion sonohysterography,transvaginal sonography and hysteroscopy in postmenopausal bleeding

Objective  

To compare the diagnostic accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) with respect to pathological diagnosis in the detection of uterine cavity abnormalities associated with abnormal uterine bleeding among postmenopausal women.     

经阴道三维超声诊断子宫内膜癌的探讨

目的探讨经阴道三维超声（3-DTVS）诊断子宫内膜癌及肌层浸润的价值。方法收集2003年4月-2005年4月在我院经手术治疗的子宫内膜癌患者72例。其中，术前64例（3-DTVS组）应用3-DTV多平面和血管成像技术以及体积测量功能诊断子宫内膜癌及肌层浸润深度进行评估；25例（MRI组）经核磁共振（MRI）检查为对照组，以手术后病理结果判断符合率，对比两组诊断子宫内膜癌及其肌层浸润情况。结果经3-DTVS诊断子宫内膜癌的符合率为89．1％，判断肌层浸润的符合率为77．1％。应用3-DTVS与MRI诊断子宫内膜癌及肌层浸润准确率两组间无显著性差异（P〉0．05）。结论3-DTVS在诊断子宫内膜癌及肌层浸润深度有诊断价值。     

Diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps

AIMS: To evaluate the diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps. METHODS: Thirty-two women whose preliminary transvaginal ultrasound suggested endometrial abnormality underwent sonohysterography. The findings were then compared with histopathological results. RESULTS: The sonohysterographic diagnosis was fibroid in seven patients, endometrial polyp in 23 patients and simple hyperplasia in two patients. Histopathological findings confirmed our diagnosis in all except three patients with endometrial polyps, who had normal secretory endometrium. Sonohysterography was found to have a sensitivity of 100%, a positive predictive value of 90% and diagnostic accuracy of 90.6%. CONCLUSION: Sonohysterography is a useful, minimally invasive and accurate technique to evaluate the pathologies involving endometrium and uterine cavity.     

Office hysteroscopy versus transvaginal ultrasonography in the evaluation of patients with excessive uterine bleeding

OBJECTIVE: Our purpose was to compare office hysteroscopy with transvaginal ultrasonography for diagnosing intrauterine pathologic disorders in patients with excessive uterine bleeding, with specimens obtained from either hysterectomy or operative hysteroscopy used to represent the true diagnosis. STUDY DESIGN: A total of 149 patients underwent office hysteroscopy between July 1993 and December 1994. They were evaluated for complaints of menorrhagia, metrorrhagia, or postmenopausal bleeding. Data encompassing patient age, gravidity, parity, indication, ultrasonographic and hysteroscopic findings, comfort level, time required, and complications were gathered by resident physicians. Most hysteroscopic examinations were preceded by transvaginal ultrasonography. All patients received premedication with 600 mg of ibuprofen and a paracervical block with 1% lidocaine without epinephrine. Sixty-five patients underwent operative hysteroscopy or hysterectomy later. The pathologic diagnoses of these specimens were compared with hysteroscopic and ultrasonographic findings, and the sensitivity and specificity of each test were calculated. RESULTS: Hysteroscopy was 79% sensitive and 93% specific in diagnosing intracavitary pathologic disorders, whereas transvaginal ultrasonography was only 54% sensitive and 90% specific. One hundred forty-one patients were comfortable during the procedure, and inspection of the uterine cavity was considered adequate in 136. The majority of procedures were completed in <10 minutes. Twenty-six patients underwent operative hysteroscopy and another 39 underwent hysterectomy. No patient who underwent operative hysteroscopy has had a recurrence of abnormal bleeding over a 12- to 30-month follow-up. CONCLUSION: Office hysteroscopy is a rapid, safe, well-tolerated, and highly accurate means of diagnosing the cause of excessive uterine bleeding. It permits patient and physician to discuss more treatment options before surgery, including outpatient operative hysteroscopic procedures. This means savings in time and in drug, procedure, professional, and hospital costs. (Am J Obstet Gynecol 1996;174:1678-82.)     

经阴道超声诊断子宫内膜癌

目的 探讨术前经阴道超声判断子宫内膜癌肌层浸润深度以及宫颈受累程度，为合理选择治疗方案提供科学依据的可能性。方法 术前应用经阴道超声对4l例子宫内膜癌患者进行了检查，测量子宫肌层浸润深度和观察宫颈受累程度。通过41例子宫内膜癌患者阴道超声影像分析，诊断肌层浸润程度及受累情况，与术后病理检查结果对照，分别计算其符合率与准确率。结果 33例绝经后子宫内膜癌患者内膜平均厚度20．54mm，41例子宫内膜癌超声影像均显示强弱不等，边缘不整，部分病例伴有不同程度的宫腔积液。与术后病理对照：超声诊断符合率97．76％，其中宫体受侵判断符合率95．12％（39／41），准确率70．73％（29／41），宫颈受累判断符合率82．93％（34／41），准确率78．05％（32／41）。结论 经阴道超声有助于子宫内膜癌术前治疗方案的合理选择。     

Comparison of saline infusion sonohysterography and hysteroscopy in diagnosis of premenopausal women with abnormal uterine bleeding

Objective

The aim of this study was to compare the diagnostic effectiveness of transvaginal sonography (TVS), saline infusion sonohysterography (SIS), and diagnostic hysteroscopy (HS), with the pathologic specimen as a gold standard diagnostic method, in detecting endometrial pathology in premenopausal women with abnormal uterine bleeding.

Study design

This prospective cohort study was conducted at Zeynep Kamil Education and Training Hospital, Istanbul, Turkey, and included 89 premenopausal women. All participants were examined first by TVS, further investigated with SIS and HS, and finally dilatation and curettage was performed when needed. The results obtained from these three methods were compared with the pathologic diagnoses. The positive and negative likelihood ratios (LR+ and LR−) of TVS, SIS and HS were calculated by comparison with the final pathological diagnosis. In addition, area under the curve (AUC) values were also calculated.

Results

Polypoid lesion was the most common abnormal pathology. LR+ and LR− of TVS, SIS, and HS were 3.13 and 0.15, 9.83 and 0.07, 13.7 and 0.02 respectively in detection of any abnormal pathology, and the AUCs of TVS, SIS, and HS were 0.804, 0.920, and 0.954 respectively. When the three procedures were compared with each other separately, HS had the best diagnostic accuracy, and the diagnostic accuracy of HS and SIS was superior to TVS (p₁ = 0.000, p₂ = 0.000). For the detection of polypoid lesions, HS was the most accurate diagnostic procedure (AUC = 0.947), followed by SIS (AUC = 0.894) and TVS (AUC = 0.778).

Conclusion

HS provides the most accurate diagnosis and allows treatment in the same session in premenopausal women with abnormal uterine bleeding.     

Comparison of transvaginal ultrasound, saline infusion sonography and hysteroscopy to investigate postmenopausal bleeding and unscheduled bleeding on HRT

A study was conducted to compare transvaginal ultrasound (TVS), saline infusion sonography (SIS) and outpatient hysteroscopy for examining the uterine cavity in women with postmenopausal bleeding and unscheduled bleeding on hormone replacement therapy (HRT). Fourty Subjects agreed to undergo TVS, SIS and hysteroscopy in addition to endometrial sampling. The abnormalities detected by each imaging method were recorded together with the discomfort (visual analogue scale). Thirty women completed all three imaging procedures. In 18 cases TVS suggested an abnormal cavity. SIS and hysteroscopy were of similar efficacy in clarifying the nature of this, and confirmed an abnormality in 12 cases (40%). TVS was significantly less painful than the other procedures (p < 0.001). SIS and hysteroscopy were associated with pain scores similar to endometrial sampling. These findings justify the need for a large randomised trial of TVS, SIS, hysteroscopy and endometrial sampling, in order to develop the most appropriate strategy for investigating postmenopausal bleeding and unscheduled bleeding on HRT.     

阴道超声对诊断治疗卵巢子宫内膜异位囊肿及子宫腺肌病的价值

目的探讨阴道超声及血清CA125测定对诊断治疗卵巢子宫内膜异位囊肿及子宫腺肌病的价值。方法对卵巢子宫内膜异位囊肿及子宫腺肌病患者631例进行回顾性分析，术前均经阴道超声检查，部分患者进行了血清CA125测定。结果阴道超声检查卵巢子宫内膜异位囊肿符合率98．7％；子宫腺肌病符合率91．7％；卵巢子宫内膜异位囊肿合并子宫腺肌病符合率95．1％。血清CA125检查卵巢子宫内膜异位囊肿，阳性率39．4％；子宫腺肌病阳性率52．2％；卵巢子宫内膜异位囊肿合并子宫腺肌病阳性率59．2％。结论阴道超声可做为较准确诊断卵巢子宫内膜异位囊肿及子宫腺肌病的首选方法。阴道超声下囊肿穿刺是治疗卵巢子宫内膜异位囊肿的简便、有效的方法之一。血清CA125测定可做为卵巢子宫内膜异位囊肿及子宫腺肌病的协助诊断方法，应进一步完善对照组的研究。