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Calaf J, Rams N, Delgado-Morell A, Mundó A. [Diagnosis of uterine myomas]. Med Clin (Barc) 2023; 161 Suppl 1:S8-S14. [PMID: 37923514 DOI: 10.1016/j.medcli.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 06/10/2023] [Accepted: 06/27/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Joaquim Calaf
- Servei d'Obstetrícia i Ginecologia i Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Noelia Rams
- Servei d'Obstetrícia i Ginecologia i Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Aina Delgado-Morell
- Servei d'Obstetrícia i Ginecologia i Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Anna Mundó
- Servei d'Obstetrícia i Ginecologia i Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
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Trémollieres FA, Chabbert-Buffet N, Plu-Bureau G, Rousset-Jablonski C, Lecerf JM, Duclos M, Pouilles JM, Gosset A, Boutet G, Hocke C, Maris E, Hugon-Rodin J, Maitrot-Mantelet L, Robin G, André G, Hamdaoui N, Mathelin C, Lopes P, Graesslin O, Fritel X. Management of postmenopausal women: Collège National des Gynécologues et Obstétriciens Français (CNGOF) and Groupe d'Etude sur la Ménopause et le Vieillissement (GEMVi) Clinical Practice Guidelines. Maturitas 2022; 163:62-81. [PMID: 35717745 DOI: 10.1016/j.maturitas.2022.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/23/2022] [Accepted: 05/17/2022] [Indexed: 12/26/2022]
Abstract
AIM The aim of these recommendations is to set forth an individualized approach to the management of early postmenopausal women (i.e., within the first 10 years after natural menopause) covering all aspects of lifestyle and therapeutic management, with or without menopause hormone therapy (MHT). MATERIALS AND METHODS Literature review and consensus of French expert opinion. Recommendations were graded according to the HAS methodology and levels of evidence derived from the international literature, except when there was no good-quality evidence. SUMMARY RECOMMENDATIONS The beginning of menopause is an ideal time for each woman to evaluate her health status by assessing her bone, cardiovascular, and cancer-related risk factors that may be amplified by postmenopausal estrogen deficiency and by reviewing her lifestyle habits. Improving lifestyle, including nutrition and physical activity, and avoiding risk factors (notably smoking), should be recommended to all women. MHT remains the most effective treatment for vasomotor symptoms but it could be also recommended as first-line treatment for the prevention of osteoporosis in early postmenopausal women at low to moderate risk for fracture. The risks of MHT differ depending on its type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. There is reasonable evidence that using transdermal estradiol in association with micronized progesterone or dydrogesterone may limit both the venous thromboembolic risk associated with oral estrogens and the risk of breast cancer associated with synthetic progestins. Treatment should be individualized to each woman, by using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of its benefit-risk balance. For bothersome genitourinary syndrome of menopause (GSM) symptoms, vaginal treatment with lubricants and moisturizers is recommended as first-line treatment together with low-dose vaginal estrogen therapy, depending on the clinical course. No recommendation of an optimal duration of MHT can be made, but it must take into consideration the initial indication for MHT as well as each woman's benefit-risk balance. Management of gynecological side-effects of MHT is also examined. These recommendations are endorsed by the Groupe d'Etude sur la Ménopause et le Vieillissement hormonal (GEMVI) and the Collège National des Gynécologues-Obstétriciens Français (CNGOF).
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Affiliation(s)
- F A Trémollieres
- Centre de Ménopause et Maladies Osseuses Métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France; Inserm U1048-I2MC-Equipe 9, Université Toulouse III Paul-Sabatier, 1, avenue du Professeur-Jean-Poulhes, BP 84225, 31432 Toulouse cedex 4, France.
| | - N Chabbert-Buffet
- Service de gynécologie obstétrique, médecine de la reproduction, APHP Sorbonne Universitaire, Site Tenon, 4, rue de la Chine, 75020 Paris, France
| | - G Plu-Bureau
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France; Université de Paris, Paris, France; Inserm U1153 Equipe EPOPEE, Paris, France
| | - C Rousset-Jablonski
- Département de chirurgie oncologique, Centre Léon Bérard, 28, Promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France; Département d'obstétrique et gynécologie, Hospices Civils de Lyon, CHU Lyon Sud, 165, Chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université Lyon, EA 7425 HESPER-Health Services and Performance Research, 8, avenue Rockefeller, 69003 Lyon, France
| | - J M Lecerf
- Service de nutrition et activité physique, Institut Pasteur de Lille, 1, rue du Professeur-Calmette, 59019 Lille cedex, France; Service de médecine interne, CHRU Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - M Duclos
- Service de médecine du sport et des explorations fonctionnelles, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, UFR Médecine, BP 10448, 63000 Clermont-Ferrand, France; INRAE, UMR 1019, UNH, CRNH Auvergne, 63000 Clermont-Ferrand, France
| | - J M Pouilles
- Centre de Ménopause et Maladies Osseuses Métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France
| | - A Gosset
- Centre de Ménopause et Maladies Osseuses Métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France
| | - G Boutet
- AGREGA, Service de chirurgie gynécologique et médecine de la reproduction, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33000 Bordeaux, France
| | - C Hocke
- Service de chirurgie gynécologique et médecine de la reproduction, Centre Aliénor d'Aquitaine, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - E Maris
- Département d'obstétrique et gynécologie, CHU Montpellier, Université Montpellier, Montpellier, France
| | - J Hugon-Rodin
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France
| | - G Robin
- Service de gynécologie médicale, orthogénie et sexologie, UF de gynécologie endocrinienne, Hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - G André
- 15, boulevard Ohmacht, 67000 Strasbourg, France
| | - N Hamdaoui
- Centre Hospitalier Universitaire Nord, Assistance publique-Hôpitaux de Marseille, Chemin des Bourrely, 13015 Marseille, France
| | - C Mathelin
- Institut de cancérologie Strasbourg Europe, 17, rue Albert-Calmette, 67200 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200 Strasbourg, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS UMR7104 Inserm U964, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
| | - P Lopes
- Nantes, France Polyclinique de l'Atlantique Saint Herblain, 44819 St Herblain, France; Université ́de Nantes, 44093 Nantes cedex, France
| | - O Graesslin
- Département de gynécologie-obstétrique, Institut Mère-Enfant Alix de Champagne, Centre Hospitalier Universitaire, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
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Pereira AEDMM, Franco J, Machado FS, Geber S. Accuracy of Transvaginal Ultrasound in the Diagnosis of Intrauterine Lesions. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:530-534. [PMID: 34461663 PMCID: PMC10305154 DOI: 10.1055/s-0041-1732462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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.
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Affiliation(s)
| | - Junia Franco
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Fernanda Silveira Machado
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Selmo Geber
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Hamdaoui N, Boubli L. [Management of side effects under hormonal replacement therapy in menopausal women: Abnormal uterine bleeding. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:474-484. [PMID: 33757921 DOI: 10.1016/j.gofs.2021.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To publish, under the aegis of the French National College of Gynecologists and Obstetricians (CNGOF) and the Study Group on Menopause and Hormonal Aging (GEMVi), recommendations based on the evidence available in the literature for the management of abnormal uterine bleeding (AUB) in women taking hormonal replacement therapy (HRT). A review of the literature was performed by consulting Medline, Cochrane Library data as well as international recommendations in French and English up to September 1, 2020. RESULTS AUB occurring in a woman taking HRT (FIGO 2011) is one of the main factors of poor adherence to the HRT. AUB must seek an organic cause including endometrial cancer. The main functional causes of AUB in a woman taking HRT are resumption of ovarian activity, poor compliance, and trophic disorders of the endometrium. AUB are dependent on the type of HRT. In the event of AUB under HRT, it is suggested to perform a pelvic ultrasound at the end of the progestational sequence in the event of sequential HRT. In a single episode of AUB and when the ultrasound estimates the endometrial thickness less than or equal to 4mm, it is possible to postpone further uterine exploration. In case of recurrent AUB or when the endometrium thickness is greater than 4mm in a postmenopausal woman, additional uterine investigations (hysteroscopy and histology) are recommended. CONCLUSION AUB under HRT must seek an organic cause. The measurement of endometrial thickness by pelvic ultrasound is relevant for screening for endometrial cancer.
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Affiliation(s)
- N Hamdaoui
- Centre hospitalier universitaire Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France.
| | - L Boubli
- Centre hospitalier universitaire Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
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Vitale SG, Haimovich S, Laganà AS, Alonso L, Di Spiezio Sardo A, Carugno J. Endometrial polyps. An evidence-based diagnosis and management guide. Eur J Obstet Gynecol Reprod Biol 2021; 260:70-77. [PMID: 33756339 DOI: 10.1016/j.ejogrb.2021.03.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To provide an updated practice guideline for the management of patients with endometrial polyps. MATERIALS AND METHODS A committee of six expert researchers draw the recommendations according to AGREE II Reporting Guideline. An electronic search was performed querying the following databases MEDLINE (accessed through PubMed), Scopus, PROSPERO, EMBASE, CINAHL, Cochrane Library (including the Cochrane Database of Systematic Reviews), Scielo.br, Google Scholar, from inception to May 2020. A combination of text-words and Medical Subject Headings (MeSH) regarding endometrial polyps, diagnosis, management and treatment was used. Trials were assessed for methodologic rigor and graded using the United States Preventive Services Task Force classification system. RECOMMENDATIONS Transvaginal ultrasonography (TVUS) should be the imaging modality of choice for the detection of endometrial polyps in woman of fertile age (level B). Its accuracy increases when color-doppler, 3D investigation and contrast are used (level B). Dilation and Curettage (D&C) should be avoided for the diagnosis and management of polyps (level A). In office hysteroscopy showed the highest diagnostic accuracy in infertile patients with suspected endometrial polyps (level B). Polyps might alter endometrial receptivity, and embryo implantation reducing pregnancy rates (level C). Hysteroscopic polypectomy is feasible and safe with negligeble risk of intrauterine adhesion formation (level B). Polypectomy does not compromise reproductive outcomes from subsequent IVF procedures but the removal of polyps as a routine practice in sub-fertile women is not currently supported by the evidence (level B). Cost-effectiveness analysis suggest performing office polypectomy in women desiring to conceive (level B). Saline infused sonohysterography is highly accurate in detecting polyps in asymptomatic postmenopausal women (level B). Postmenopausal women with vaginal bleeding and suspected endometrial polyp should be offered diagnostic hysteroscopy with hysteroscopic polypectomy if endometrial polyps are present (level B). In-office hysteroscopy has the highest diagnostic accuracy with high cost-benefits ratio for premalignant and malignant pathologies of the uterine cavity (level B). Due to risk of malignancy, histopathological analysis of the polyp is mandatory (level B). Blind D&C should be avoided due to inaccuracy for the diagnosis of focal endometrial pathology (level A). Expectant management is not recommended in symptomatic patients especially in postmenopausal women (level B). In case of atypical hyperplasia or carcinoma on a polyp, hysterectomy is recommended in all post-menopausal patients and in premenopausal patients without desire of future fertility (level B). Asymptomatic endometrial polyps in postmenopausal women should be removed in case of large diameter (> 2 cm) or in patients with risk factors for endometrial carcinoma (level B). Excision of polyps smaller than 2 cm in asymptomatic postmenopausal patients has no impact on cost-effectiveness or survival (level B). Removal of asymptomatic polyps in premenopausal women should be considered in patients with risk factors for endometrial cancer (level B).
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Affiliation(s)
- Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Sergio Haimovich
- Hillel Yaffe Medical Center, Technion-Israel Technology Institute, Hadera, Israel
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Luis Alonso
- Centro Gutenberg, Endoscopy Unit, Malaga, Spain
| | | | - Jose Carugno
- Department of Obstetrics, Gynecology and Reproductive Sciences, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, 1321 NW 14(th) Street Suite 201, Miami, FL 33136, USA.
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Tsonis O, Gkrozou F, Dimitriou E, Paschopoulos M. Comparative retrospective study on transvaginal sonography versus office hysteroscopy in the diagnosis of endometrial pathology among different subgroups. J Obstet Gynaecol Res 2020; 47:669-678. [PMID: 33258221 DOI: 10.1111/jog.14580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/19/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- Orestis Tsonis
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece
| | - Fani Gkrozou
- Department of Obstetrics and Gynaecology, University Hospitals of Birmingham, Birmingham, UK
| | | | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece
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Sanin-Ramirez D, Carriles I, Graupera B, Ajossa S, Neri M, Rodriguez I, Pascual MÁ, Guerriero S, Alcázar JL. Two-dimensional transvaginal sonography vs saline contrast sonohysterography for diagnosing endometrial polyps: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:506-515. [PMID: 32730635 DOI: 10.1002/uog.22161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare the diagnostic performance of two-dimensional transvaginal sonography (TVS) and saline contrast sonohysterography (SCSH) for the diagnosis of endometrial polyps in studies that used both tests in the same group of patients. METHODS This was a systematic review and meta-analysis. An extensive search was conducted of Medline (PubMed), Cochrane Library and Web of Science, for studies comparing the diagnostic performance of TVS and SCSH for identifying endometrial polyps, published between January 1990 and December 2019, that reported a definition of endometrial polyp on TVS and SCSH and used pathologic analysis as the reference standard. Quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. A random-effects model was used to determine pooled sensitivity, specificity and positive and negative likelihood ratios of TVS and SCSH in the detection of endometrial polyps. Subanalysis according to menopausal status was performed. RESULTS In total, 1278 citations were identified; after exclusions, 25 studies were included in the meta-analysis. In the included studies, the risk of bias evaluated using QUADAS-2 was low for most of the four domains, except for flow and timing, which had an unclear risk of bias in 13 studies. Pooled sensitivity, specificity and positive and negative likelihood ratios for TVS in the detection of endometrial polyps were 55.0% (95% CI, 46.0-64.0%), 91.0% (95% CI, 86.0-94.0%), 5.8 (95% CI, 3.9-8.7) and 0.5 (95% CI, 0.41-0.61), respectively. The corresponding values for SCSH were 92.0% (95% CI, 87.0-95.0%), 93.0% (95% CI, 91.0-95.0%), 13.9 (95% CI, 9.9-19.5) and 0.08 (95% CI, 0.05-0.14), respectively. Significant differences were found when comparing the methods in terms of sensitivity (P < 0.001), but not for specificity (P = 0.0918). Heterogeneity was high for TVS and moderate for SCSH. On subanalysis according to menopausal status, SCSH was found to have higher diagnostic accuracy in both pre- and postmenopausal women; sensitivity and specificity did not differ significantly between the groups for either TVS or SCSH. CONCLUSION Given that SCSH has better diagnostic positive and negative likelihood ratios than does TVS in both pre- and postmenopausal women, those with clinical suspicion of endometrial polyps should undergo SCSH if TVS findings are inconclusive. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Sanin-Ramirez
- Department of Obstetrics and Gynecology, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - I Carriles
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - B Graupera
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - S Ajossa
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Cagliari, Italy
| | - M Neri
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Cagliari, Italy
| | - I Rodriguez
- Biostatistics and Epidemiology Unit, Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - M Á Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Cagliari, Italy
| | - J L Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
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TOKALIOGLU A, DİLBAZ B, ÖZELÇİ R, TOKALIOGLU E, ÇOŞKUN B. Asemptomatik postmenopozal kadınlardaki endometrial patolojilerin değerlendirilmesinde sonohisterobiopsinin yeri var mı? CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.690986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography, and hysteroscopy in evaluating the endometrial polyps in women with abnormal uterine bleeding: a systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne 2020; 15:403-415. [PMID: 32904526 PMCID: PMC7457193 DOI: 10.5114/wiitm.2020.93791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/23/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction In women with abnormal uterine bleeding (AUB), endometrial polyps are a frequent finding, and the risk of a focal (pre)malignancy in a polyp is up to 6%. Because of this reported risk, the detection of polyps in these women is important. Aim To evaluate and compare the diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography, and hysteroscopy in detecting endometrial polyps in women with AUB. Material and methods The searches were conducted by two independent researchers to find the relevant studies published from 1/1/2009 until the end of 30/06/2019. We searched for published literature in English language in MEDLINE, EMBASETM, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID), KoreaMed, and LILACS. The risk of bias of every article was evaluated by using QUADAS-2. Results After selection and quality assessment, 11 studies were included. Based on the random effect model the total prevalence of endometrial polyps in women with abnormal uterine bleeding was 38%. The sensitivity and specificity of saline infusion sonohysterography in diagnosis of endometrial polyps were 0.87 and 0.86, respectively. The sensitivity and specificity of transvaginal ultrasonography were 0.62 and 0.73 and the sensitivity and specificity of hysteroscopy were 0.92 and 0.85, respectively. Conclusions Although that sonohysterography is a safe and relatively cheap method, which allows ruling out or confirming endometrial polyps, it cannot be replaced with hysteroscopy due to the fact that hysteroscopy combined with biopsy is the gold standard for ruling out malignancies in an endometrial polyp.
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Poliakova Y, Lutsenko N. Diagnostic Accuracy of Transvaginal Sonography in the Detection of Endometrial Polyps. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479319879374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Transvaginal sonography (TVS) is considered a simple and generally accepted method for detecting uterine anomalies. With TVS, the uterus can be clearly visualized, but so far, the diagnostic accuracy of TVS varies across different studies. This retrospective study was devised to evaluate the accuracy of a sonographic diagnosis of endometrial polyps in a Ukrainian hospital. Methods: This was a single-center retrospective study of woman who underwent TVS and had hysteroscopy or dilation and curettage for endometrial pathology. A cohort of 156 women were included in this yearlong study. A comparative analysis was based on the preoperative diagnosis, according to TVS, compared with the postoperative histopathology results. Results: The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of TVS in diagnosing endometrial polyps were 69%, 51%, 73%, 46%, and 63%, respectively. Conclusion: This retrospective study provided data on the lack of accuracy for a sonographic diagnosis of endometrial polyps. This was based on 26% of women whose diagnosis was not confirmed by histology. A false-negative result occurred for 54% of women who had polyps that were not detected at the preoperative stage. These data raise the question of the feasibility of further invasive procedures based on a single TVS study.
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Affiliation(s)
| | - Nataliia Lutsenko
- Department of Obstetrics and Gynecology, SI Zaporizhzhia Medical Academy of Post-Graduate Education of Ministry of Health of Ukraine, Zaporizhzhia, Ukraine
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Moradan S, Darzi SN, Ghorbani R. Diagnostic value of saline infusion sonohysterography for detecting endometrial focal lesion. Pan Afr Med J 2019; 33:211. [PMID: 31693718 PMCID: PMC6814347 DOI: 10.11604/pamj.2019.33.211.16563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 03/08/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Different diagnostic tools are available to evaluate endometrial focal lesion such as hysteroscopy, sonohystrography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with Abnormal Uterine Bleeding (AUB). Methods This cross-sectional study recruited 100 married women with chief complain of AUB referred to gynecologic clinics at the Amir Al-Momenin hospital, Semnan, Iran from March 2014 to February 2016. All participants were in the reproductive age and post-menopausal period that showed abnormal endometrial thickness or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus focal lesion resection and endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist. Results Mean±SD age of women was 41.2±11.3 years. To diagnose the overall focal lesions, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SIS were 79.6, 89.1, 89.6, and 78.8% respectively. These figures were 75.0, 87.5, 82.5 and 81.7%, respectively to diagnose polyps. The SIS sensitivity, specificity, PPV and NPV values to diagnose the myomas were 60.0, 97.8, 75.0, and 95.7% respectively. Conclusion Findings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.
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Affiliation(s)
- Sanam Moradan
- Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Raheb Ghorbani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Vroom AJ, Timmermans A, Bongers MY, van den Heuvel ER, Geomini PMAJ, van Hanegem N. Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:28-34. [PMID: 30693579 DOI: 10.1002/uog.20229] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 12/25/2018] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE In women with postmenopausal bleeding, endometrial polyps are a frequent finding and the risk of a focal (pre)malignancy in a polyp is up to 6%. Because of this reported risk, the detection of polyps in these women, preferably by a minimally invasive method, is important. The aim of this systematic review was to assess the accuracy of saline contrast sonohysterography (SCSH) for diagnosis of endometrial polyps in women with postmenopausal bleeding. METHODS In August 2018, an electronic search was performed of MEDLINE, EMBASE and Web of Science databases to identify all diagnostic studies in which SCSH was used to detect endometrial polyps in postmenopausal women. Studies were included if SCSH was performed to detect endometrial polyps in women with postmenopausal bleeding and if detection of a polyp on hysteroscopy or diagnosis on histopathology was used as a reference standard. Two reviewers assessed methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Two separate analyses were performed for each reference standard. Pooled sensitivity and specificity were calculated using the hierarchical summary receiver-operating characteristics (HSROC) model and HSROC curves were plotted. RESULTS After selection and quality assessment, five studies were included. Using 'polyps diagnosed with histopathology' as the reference standard, the pooled sensitivity of SCSH was 86.5% (95% CI, 63.6-100%) and the pooled specificity was 91.1% (95% CI, 63.2-100%). Using 'polyps seen on hysteroscopy' as the reference standard, the pooled sensitivity of SCSH was 85.1% (95% CI, 66.9-100%) and the pooled specificity was 84.5% (95% CI, 68.1-100%). Excluding the one study that included women in whom the SCSH examination was reported to be suboptimal, the pooled sensitivity increased to 90.7% (95% CI, 72.8-100%) using hysteroscopy as the reference standard. The sensitivity of hysteroscopy to detect polyps, as reported in two studies, was 81-98%. CONCLUSIONS Provided that the SCSH examination is of optimal quality, it can be considered as a method to stratify women with postmenopausal bleeding for further diagnostic workup and treatment with hysteroscopy. In women without suspicion of a polypoid lesion on SCSH, and with a benign endometrial sample, expectant management should be considered. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A J Vroom
- Department of Obstetrics and Gynecology, Maastricht UMC+, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
- Department of Gynecology and Obstetrics, Maxima Medisch Centrum, Veldhoven, The Netherlands
| | - A Timmermans
- Department of Gynecology, Amsterdam Medisch Centrum, Amsterdam, The Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynecology, Maastricht UMC+, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
- Department of Gynecology and Obstetrics, Maxima Medisch Centrum, Veldhoven, The Netherlands
| | - E R van den Heuvel
- Department of Stochastics W&I, Technische Universiteit, Eindhoven, The Netherlands
| | - P M A J Geomini
- Department of Gynecology and Obstetrics, Maxima Medisch Centrum, Veldhoven, The Netherlands
| | - N van Hanegem
- Department of Obstetrics and Gynecology, Maastricht UMC+, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
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Namazov A, Gemer O, Bart O, Cohen O, Vaisbuch E, Kapustian V, Ben-Arie A. Effect of Menopausal Status on the Diagnosis of Endometrial Polyp. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:926-929. [DOI: 10.1016/j.jogc.2018.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022]
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Is outpatient hysteroscopy accurate for the diagnosis of endometrial pathology among perimenopausal and postmenopausal women? Menopause 2019; 25:160-164. [PMID: 28763396 DOI: 10.1097/gme.0000000000000961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the histological and visual accuracy of outpatient hysteroscopy. METHODS This was a retrospective analysis of all women referred to a tertiary center outpatient hysteroscopy clinic between March 2011 and October 2016 for the following indications: postmenopausal bleeding, suspected polyp, and/or thick endometrium. Histological accuracy was evaluated by comparing specimens obtained in hysteroscopy with those obtained by hysterectomy, and visual accuracy was evaluated by comparing visual findings with those obtained by biopsies. Sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio were calculated to assess visual accuracy. RESULTS The mean age of participants was 54.14 (interquartile range 43.0-64.0). A total of 408 pathological specimens were obtained from outpatient hysteroscopies during the 712 visits recorded in the clinic log. Histological accuracy was evaluated in 15 participants who eventually underwent hysterectomy. Total percent of agreement between hysteroscopy biopsies and final pathology obtained by hysterectomy was 73% (kappa = 0.47). Overall visual accuracy was calculated with a 93.1% sensitivity, 52.1% specificity, 90.4% positive predictive value, and 61.0% negative predictive value. Visual accuracy for benign pathology was generally higher compared with that for pre and malignant lesions. Visual accuracy was satisfactory for the diagnosis of endometrial carcinoma with sensitivity and specificity of 71.4% and 98.9%, respectively, but poor for diagnosing hyperplasia with sensitivity and specificity of 25.0% and 96.6%, respectively. CONCLUSIONS Outpatient hysteroscopy is an adequate and reliable tool for the evaluation of benign pathology in the uterine cavity. Visual findings may not suffice, and directed biopsies may be required to improve diagnostic accuracy.
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Yela DA, Pini PH, Benetti-Pinto CL. Comparison of endometrial assessment by transvaginal ultrasonography and hysteroscopy. Int J Gynaecol Obstet 2018; 143:32-36. [PMID: 29904926 DOI: 10.1002/ijgo.12567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/03/2018] [Accepted: 06/13/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To compare transvaginal ultrasonography and hysteroscopy for the diagnosis of endometrial pathologies. METHODS In the present retrospective cohort study, data were reviewed from women with ultrasonography findings suggestive of endometrial lesions and/or abnormal uterine bleeding who underwent hysteroscopy at a single center in Campinas, Brazil, between January 2011 and December 2013; data were stratified based on reproductive-aged and postmenopausal groups. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasonography and hysteroscopy for the diagnosis of endometrial lesions were determined. Histopathology was used as the gold standard. RESULTS There were 754 patients included (256 reproductive age, 498 postmenopausal). In the reproductive-age group, ultrasonography had a sensitivity of 96.0%, specificity of 58.0%, PPV of 94.4%, NPV of 66.6%, and accuracy of 91.5%, whereas hysteroscopy had a sensitivity of 91.8%, specificity of 76.6%, PPV of 96.0%, NPV of 60.5%, and accuracy of 89.7% for the diagnosis of endometrial disease. In the postmenopausal group, ultrasonography had a sensitivity of 99.0%, specificity of 19.0%, PPV of 96.1%, NPV of 50.0%, and accuracy of 95.3%, whereas hysteroscopy had a sensitivity of 96.7%, specificity of 86.9%, PPV of 99.2%, NPV of 58.8%, and accuracy of 96.2%. CONCLUSION Ultrasonography was found to be an effective method for the diagnosis of endometrial disease, especially among postmenopausal women.
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Affiliation(s)
- Daniela A Yela
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Patricia H Pini
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
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Kumar P, Mohan S, Talwar P, Rai S, Nagaraja N, Sharma P. Diagnostic Office Vaginohysteroscopy in Evaluation of Infertility Prior to IVF: A Retrospective Analysis of 1000 Cases. J Obstet Gynaecol India 2017; 67:275-281. [PMID: 28706367 DOI: 10.1007/s13224-017-0972-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022] Open
Abstract
AIM The aim of this study was to analyze the utility of routine use of diagnostic office vaginohysteroscopy in the evaluation of uterine cavity in infertility patients prior to IVF-ET. MATERIALS AND METHODS We conducted a retrospective analysis of 1000 women who had undergone routine diagnostic office vaginohysteroscopy as an institutional protocol in the evaluation of infertility prior to IVF-ET cycle at a tertiary care hospital. They were divided into two groups: primary infertility (group I) and secondary infertility (group II). The primary outcome was the finding of an abnormal uterine cavity (congenital abnormality vs acquired abnormality). RESULTS One thousand women underwent routine diagnostic office vaginohysteroscopy in the evaluation of infertility prior to IVF-ET. There were no intraoperative or postoperative complications. Vaginohysteroscopy revealed an abnormal uterine cavity in 13.8% (1000 patients) of women. Primary infertility group (I) had 13.19% (811 patients), and secondary infertility group (II) had 16.4% (189 patients) abnormal uterine cavities. CONCLUSION Diagnostic office vaginohysteroscopy has a definite role in the uterine cavity evaluation in infertility patients prior to IVF, but routine use should not be recommended considering the low incidence of abnormal uterine cavity findings. Moreover, the majority of these uterine cavity abnormalities can be detected by less invasive tests such as HSG, TVS, SSG and 3D ultrasound.
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Affiliation(s)
- Praveen Kumar
- ART Centre, Army Hospital (Research & Referral), Delhi Cantt, India
| | - Surender Mohan
- ART Centre, Army Hospital (Research & Referral), Delhi Cantt, India
| | - Pankaj Talwar
- ART Centre, Army Hospital (Research & Referral), Delhi Cantt, India
| | - Seema Rai
- ART Centre, Army Hospital (Research & Referral), Delhi Cantt, India
| | - N Nagaraja
- ART Centre, Army Hospital (Research & Referral), Delhi Cantt, India
| | - Prashant Sharma
- ART Centre, Army Hospital (Research & Referral), Delhi Cantt, India
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Turnbull HL, Akrivos N, Simpson P, Duncan TJ, Nieto JJ, Burbos N. Investigating vaginal bleeding in postmenopausal women found to have an endometrial thickness of equal to or greater than 10 mm on ultrasonography. Arch Gynecol Obstet 2016; 295:445-450. [PMID: 27909879 DOI: 10.1007/s00404-016-4249-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/22/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE This aim of this study is to determine the risk of endometrial cancer in symptomatic postmenopausal women, when endometrial thickness on transvaginal ultrasonography is equal to or greater than 10 mm, and subsequent office-based endometrial sampling histology is negative. METHODS This is a prospective cross-sectional study, performed in a gynaecological oncology centre in the United Kingdom between February 2008 and July 2012. All postmenopausal women presenting with vaginal bleeding were investigated using transvaginal ultrasonography. Women with endometrial thickness measurements equal to or greater than 10 mm and negative office-based endometrial biopsy underwent hysteroscopy and endometrial biopsies. RESULTS Over a 52-month period, 4148 women were investigated for postmenopausal vaginal bleeding. 588 (14.2%) women were found to have endometrial thickness measurements of equal to or greater than 10 mm on transvaginal ultrasonography. 170 (28.9%) cases of endometrial cancer were diagnosed in this group: 149 (87.6%) of the cancer cases were diagnosed in the outpatient setting with a Pipelle® endometrial sampler, whilst 21 (12.4%) had a negative Pipelle® sample and were diagnosed with hysteroscopy. The group diagnosed with hysteroscopy had lower BMI (32.7 kg/m2 versus 39.7 kg/m2, p < 0.001) whilst the group diagnosed with Pipelle was more likely to have a history of hypertension and diabetes mellitus (p = 0.019 for both). The sensitivity of Pipelle was 87.65%. CONCLUSION For women presenting with postmenopausal bleeding and where the endometrial thickness is equal to or greater than 10 mm and Pipelle sampling is negative, hysteroscopic evaluation with directed biopsy is strongly recommended.
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Affiliation(s)
- Hilary L Turnbull
- Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
| | - Nikolaos Akrivos
- Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Paul Simpson
- Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Timothy J Duncan
- Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Joaquin J Nieto
- Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Nikolaos Burbos
- Department of Obstetrics and Gynecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
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Maheux-Lacroix S, Li F, Laberge PY, Abbott J. Imaging for Polyps and Leiomyomas in Women With Abnormal Uterine Bleeding. Obstet Gynecol 2016; 128:1425-1436. [DOI: 10.1097/aog.0000000000001776] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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A Comparative Observational Study of the Use of Saline Uterine Hydrosonography for the Diagnosis and Assessment of Uterine Cavity Lesions in Women. Int J Reprod Med 2016; 2016:9317194. [PMID: 27597989 PMCID: PMC4997023 DOI: 10.1155/2016/9317194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 07/14/2016] [Indexed: 11/24/2022] Open
Abstract
Aim of this study was to evaluate the performance of saline hydrosonography (HSGM) (also known as saline infusion sonography (SIS)) against transvaginal ultrasound scan (TVS) and hysteroscopy in the diagnosis of uterine cavity lesions. Diagnostic hysteroscopy with biopsy is considered as the “gold standard” to diagnose intrauterine abnormalities. The introduction of HSGM has improved the diagnostic capability of ultrasound. It is important to establish the efficacy and safety of HSGM before it is widely recommended for use. This retrospective observational data was collected from all 223 patients who underwent TVS, HSGM, and hysteroscopy as part of their gynaecological investigations from 1 January 2008 to 31 December 2010 at Central Middlesex Hospital, London. Endometrial Polyps. TVS: sensitivity 60.53%, specificity 97.06%, positive predictive value (PPV) 95.83%, and negative predictive value (NPV) 68.75% and HSGM: sensitivity 95%, specificity 97.14%, PPV 97.44%, and NPV 94.44%. Submucous Leiomyoma. TVS: sensitivity 57.14%, specificity 93.48%, PPV 84.21%, and NPV 78.18% and HSGM: sensitivity 96.55%, specificity 100.00%, PPV 100.00%, and NPV 97.92%. Diagnostic efficacy of HSGM is superior to TVS for the diagnosis of endometrial polyps and submucous fibroids. HSGM should be considered as an intermediate investigation after TVS to assess intracavity pathology and to confirm the diagnosis; hysteroscopy should become a therapeutic intervention.
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Is Hysteroscopy Better than Ultrasonography for Uterine Cavity Evaluation? An Evidence-Based and Patient-Oriented Approach. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Evaluation of the uterine cavity is an important part of the gynecological check, especially in symptomatic women and, over the last few decades, a number of technical and technological advancements has allowed a superb investigation of this organ. Traditionally, transvaginal ultrasound (TVUS) has been the first-line diagnostic tool for evaluating uterine diseases, also considering that gynecologists are familiar with the technique since it is included in the basic training in obstetrics and gynecology. Nevertheless, to date “office hysteroscopy” received growing attention since the development of smaller-diameter hysteroscopes which has made it possible to easily perform the hysteroscopy in ambulatory settings, obviating the need for anesthesia and dilatation of the cervical canal. According to our overview, none of the available methods for endometrial evaluation are ideal and each one has pros and cons. TVUS allows assessment of both the myometrium and the endometrium and typically offers greater patient comfort, but it has a higher false-negative rate in diagnosing focal intrauterine pathology. On the other hand, office hysteroscopy has the advantage of providing (most of the time) a real-time diagnosis avoiding anxiety, inconvenience and costs associated with follow-up appointments. The main advantage of the office hysteroscopy on the TVUS is the possibility to perform an operative phase if necessary during the examination itself. In fact, the modern smaller-diameter hysteroscopes have a working channel through which operative miniaturized instruments (mechanical instruments or bipolar electrodes) can be introduced, allowing the performance of target-eye biopsies and the “instant” treatment of most of uterine diseases in outpatient settings.
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Cogendez E, Eken MK, Bakal N, Gun I, Kaygusuz EI, Karateke A. The role of transvaginal power Doppler ultrasound in the differential diagnosis of benign intrauterine focal lesions. J Med Ultrason (2001) 2015; 42:533-40. [PMID: 26576978 DOI: 10.1007/s10396-015-0628-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/25/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this prospective study was to assess the role of power Doppler imaging in the differential diagnosis of benign intrauterine focal lesions such as endometrial polyps and submucous myomas using the characteristics of power Doppler flow mapping. METHODS A total of 480 premenopausal patients with abnormal uterine bleeding were evaluated by transvaginal ultrasonography (TVS) searching for intrauterine pathology. Sixty-four patients with a suspicious focal endometrial lesion received saline infusion sonography (SIS) after TVS. Fifty-eight patients with focal endometrial lesions underwent power Doppler ultrasound (PDUS). Three different vascular flow patterns were defined: Single vessel pattern, multiple vessel pattern, and circular flow pattern. Finally, hysteroscopic resection was performed in all cases, and Doppler flow characteristics were then compared with the final histopathological findings. RESULTS Histopathological results were as follows: endometrial polyp: 40 (69 %), submucous myoma: 18 (31 %). Of the cases with endometrial polyps, 80 % demonstrated a single vessel pattern, 7.5 % a multiple vessel pattern, and 0 % a circular pattern. Vascularization was not observed in 12.5 % of patients with polyps. Of the cases with submucousal myomas, 72.2 % demonstrated a circular flow pattern, 27.8 % a multiple vessel pattern, and none of them showed a single vessel pattern. The sensitivity, specificity, and positive and negative predictive values of the single vessel pattern in diagnosing endometrial polyps were 80, 100, 100, and 69.2 %, respectively; and for the circular pattern in diagnosing submucous myoma, these were 72.2, 100, 100, and 88.9 %, respectively. CONCLUSION Power Doppler blood flow mapping is a useful, practical, and noninvasive diagnostic method for the differential diagnosis of benign intrauterine focal lesions. Especially in cases of recurrent abnormal uterine bleeding, recurrent abortion, and infertility, PDUS can be preferred as a first-line diagnostic method.
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Affiliation(s)
- Ebru Cogendez
- Gynecology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.
| | - Meryem Kurek Eken
- Gynecology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Nuray Bakal
- Radiology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ismet Gun
- Gynecology Department, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ecmel Isik Kaygusuz
- Pathology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ates Karateke
- Gynecology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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Reproducibility of Endometrial Pathologic Findings Obtained on Hysteroscopy, Transvaginal Sonography, and Gel Infusion Sonography in Women With Postmenopausal Bleeding. J Minim Invasive Gynecol 2015; 22:1036-44. [PMID: 26044592 DOI: 10.1016/j.jmig.2015.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVE To evaluate and compare interobserver variation in endometrial pattern recognition with hysteroscopy (HY) and transvaginal sonography (TVS) and gel infusion sonography (GIS) with regard to the diagnosis of endometrial pathology. DESIGN Prospective study (Canadian Task Force II-1). SETTING University clinic. PATIENTS One hundred twenty-two consecutive women with postmenopausal bleeding and an endometrium thickness ≥ 5 mm. INTERVENTION Two observers using HY and 2 others using TVS and GIS evaluated the endometrial pattern in recorded video clips. Interobserver agreement regarding findings obtained with TVS, GIS, and HY for a diagnosis of cancer, hyperplasia, polyps, and no endometrial pathology was expressed by κ coefficients and compared. MEASUREMENT AND MAIN RESULTS Interobserver agreement (κ) was as follows: identification of normal endometrium: HY (.74), TVS (.68), and GIS (.48); diagnosis of cancer: HY (.56), TVS (.59), and GIS (.34); classification in all categories of endometrial pathology: HY (.70), TVS (.47), and GIS (.41) (p < .05 HY vs GIS). The presence of additional endometrial polyps decreased agreement on HY in patients with hyperplasia or cancer. Observer agreement was poor regarding the diagnosis of hyperplasia by all techniques. CONCLUSION Observer agreement regarding both HY and TVS was reliable for the diagnosis of a normal endometrium but poor with HY, TVS, and especially GIS for a diagnosis of cancer. In patients with hyperplasia or cancer, agreement between observers was especially low in the presence of additional polyps when HY was used. These findings call attention to the need for systematic methods to improve reliability in endometrial pattern recognition.
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Hysteroscopy in women with abnormal uterine bleeding: a meta-analysis on four major endometrial pathologies. Arch Gynecol Obstet 2014; 291:1347-54. [DOI: 10.1007/s00404-014-3585-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
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Munro MG. Investigation of women with postmenopausal uterine bleeding: clinical practice recommendations. Perm J 2013; 18:55-70. [PMID: 24377427 DOI: 10.7812/tpp/13-072] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Postmenopausal uterine bleeding is defined as uterine bleeding after permanent cessation of menstruation resulting from loss of ovarian follicular activity. Bleeding can be spontaneous or related to ovarian hormone replacement therapy or to use of selective estrogen receptor modulators (eg, tamoxifen adjuvant therapy for breast carcinoma). Because anovulatory "cycles" with episodes of multimonth amenorrhea frequently precede menopause, no consensus exists regarding the appropriate interval of amenorrhea before an episode of bleeding that allows for the definition of postmenopausal bleeding. The clinician faces the possibility that an underlying malignancy exists, knowing that most often the bleeding comes from a benign source. Formerly, the gold-standard clinical investigation of postmenopausal uterine bleeding was institution-based dilation and curettage, but there now exist office-based methods for the evaluation of women with this complaint. Strategies designed to implement these diagnostic methods must be applied in a balanced way considering the resource utilization issues of overinvestigation and the risk of missing a malignancy with underinvestigation. Consequently, guidelines and recommendations were developed to consider these issues and the diverse spectrum of practitioners who evaluate women with postmenopausal bleeding. The guideline development group determined that, for initial management of spontaneous postmenopausal bleeding, primary assessment may be with either endometrial sampling or transvaginal ultrasonography, allowing patients with an endometrial echo complex thickness of 4 mm or less to be managed expectantly. Guidelines are also provided for patients receiving selective estrogen receptor modulators or hormone replacement therapy, and for an endometrial echo complex with findings consistent with fluid in the endometrial cavity.�
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Affiliation(s)
- Malcolm G Munro
- Chair of the Southern California Permanente Medical Group's Abnormal Uterine Bleeding Working Group, Director of Gynecological Services for the Los Angeles Medical Center in California, and a Professor in the Department of Obstetrics and Gynecology at the David Geffen School of Medicine at the University of California Los Angeles.
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Vitner D, Filmer S, Goldstein I, Khatib N, Weiner Z. A comparison between ultrasonography and hysteroscopy in the diagnosis of uterine pathology. Eur J Obstet Gynecol Reprod Biol 2013; 171:143-5. [DOI: 10.1016/j.ejogrb.2013.08.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/09/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
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26
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Adel M, Kandil M, Abo-Elnasr M, Sanad Z, Farag H. Three-dimensional sonohysterography may replace hysteroscopy for women with perimenopausal bleeding. Climacteric 2013; 17:55-9. [DOI: 10.3109/13697137.2013.801014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C). Arch Gynecol Obstet 2012; 286:1277-82. [DOI: 10.1007/s00404-012-2438-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 06/14/2012] [Indexed: 11/26/2022]
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