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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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Saadia Z, Farrukh R, Rasool MG. Efficacy of Foley's Catheter and the Effect of Histopathology, Age and Endometrial Thickness Relative to the Measured Outcomes in Menorrhagia. J Clin Diagn Res 2017; 11:QC05-QC09. [PMID: 28892979 DOI: 10.7860/jcdr/2017/26639.10271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 05/06/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Menorrhagia adversely affects the quality of life. Hysterectomy is the definitive treatment for menorrhagia however, a number of conservative alternatives are available. AIM Hysterectomy is the definitive treatment for menorrhagia however, a number of conservative alternatives are available. A thermal balloon is an effective but costly option. We used a Foley's catheter as an alternative to commercially available thermal balloons. If effective, it will provide a cheap alternative to the thermal balloon. MATERIALS AND METHODS A Foley's catheter was placed in the uterine cavity for 10 minutes using 0.9% saline. The measured outcomes were amenorrhea, eumenorrhea, oligomenorrhea or failure of the therapy. Endometrial thickness, age and endometrial biopsy results were also measured to determine if these variables had any effects on the outcome. RESULTS Out of the total 42 participants, nearly half had amenorrhea (42.9%, n=18). Furthermore, 28.6% had oligomenorrhea (n=12) and 26.2% experienced eumenorrhea (n=11). Only one participant failed to respond (2.4%, n=1). There were no differences in outcomes between the different forms of histopathology. This means that thermal balloon therapy is effective in causing amenorrhea. No significant relationships existed between participants' measured outcomes and a model containing predictor variables (age and endometrial thickness), R=0.313, R2=0.098, p=0.141. CONCLUSION A Foley's catheter is effective with reasonable measured outcomes in cases of menorrhagia.
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Affiliation(s)
- Zaheera Saadia
- Associate Professor, Department of Obstetrics and Gynaecology, Qassim University, Buraidah, Al Qassim, Saudi Arabia
| | - Robina Farrukh
- Associate Professor, Department of Obstetrics and Gynaecology, Fatima Jinnah Medical College, Lahore, Punjab, Pakistan
| | - Madiha Ghulam Rasool
- Medical Officer, Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, Lahore, Punjab, Pakistan
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Hysteroscopy and treatment of uterine polyps. Best Pract Res Clin Obstet Gynaecol 2015; 29:908-19. [DOI: 10.1016/j.bpobgyn.2015.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/05/2015] [Indexed: 11/20/2022]
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Yang PY, Wu JL, Wu PW, Wu CH, Lin CJ, Fan LR, Yang YH, Yeh GP. Accuracy of Transvaginal Ultrasonography for Detecting Intrauterine Lesions at a Taiwan Medical Center: A Correlation with Ultrasound and Hysteroscopic Histopathology. J Med Ultrasound 2014. [DOI: 10.1016/j.jmu.2013.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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AAGL Practice Report: Practice Guidelines for the Diagnosis and Management of Endometrial Polyps. J Minim Invasive Gynecol 2012; 19:3-10. [DOI: 10.1016/j.jmig.2011.09.003] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 09/03/2011] [Indexed: 01/02/2023]
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Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and Management of Endometrial Polyps: A Critical Review of the Literature. J Minim Invasive Gynecol 2011; 18:569-81. [DOI: 10.1016/j.jmig.2011.05.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/18/2011] [Accepted: 05/26/2011] [Indexed: 01/02/2023]
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Premkumar A, Venzon DJ, Avila N, Johnson DV, Remaley AT, Forman MR, Eng-Wong J, Zujewski J, Stratton P. Gynecologic and hormonal effects of raloxifene in premenopausal women. Fertil Steril 2007; 88:1637-44. [PMID: 17662283 DOI: 10.1016/j.fertnstert.2007.01.095] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 01/12/2007] [Accepted: 01/12/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the effects of raloxifene on the ovaries, uterus, and serum hormone levels in premenopausal women. DESIGN Prospective study comparing pretreatment findings with findings for those on treatment. SETTING Government research hospital. PATIENT(S) Thirty women 35 to 47 years of age who were at high risk of breast cancer and had regular, ovulatory menstrual cycles. INTERVENTION(S) Raloxifene (60 mg) and calcium (1,200 mg) daily for 2 years. MAIN OUTCOME MEASURE(S) Sonographic evidence of ovarian stimulation (>or=2 corpora lutea, or follicular cysts of >2 cm, or single follicular cyst of >3 cm). Changes in endometrial thickness, fibroid size, hormone levels, and menstrual-cycle length. RESULT(S) Fifteen subjects developed some cycles with asymptomatic ovarian stimulation, and 9 developed benign endometrial polyps, compared with 2 subjects and 1 subject pretreatment, respectively. Uterine fibroid size was unchanged during raloxifene use in 16 subjects with fibroids. On treatment, E(2) levels increased significantly only during the follicular phase, with peak E(2) levels significantly higher in cycles showing ovarian stimulation compared with those without. Sex hormone-binding globulin increased, but levels of LH, FSH, P, DHEAS, and T did not. Endometrial thickness and cycle length were unchanged. CONCLUSION(S) Premenopausal subjects receiving raloxifene showed sonographic and hormonal evidence of ovarian stimulation. Endometrial thickness, cycle length, and fibroid size were unchanged. Benign asymptomatic endometrial polyps developed in some.
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Affiliation(s)
- Ahalya Premkumar
- Department of Diagnostic Radiology, Warren G. Magnuson Clinical Center, Bethesda, Maryland, USA.
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Zamurović M, Srbinović P, Petrović J. [Role of hydrosonography in prevention and screening of premalignant and malignant endometrial disease]. SRP ARK CELOK LEK 2007; 134:516-20. [PMID: 17304766 DOI: 10.2298/sarh0612516z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The study emphasizes the significance of hydrosonography in prevention and early diagnostics of endometrial pathology. OBJECTIVE To express the significance of hydrosonography in relation to timely detection and treatment of premalignant and malignant endometrial disease. METHOD Our study included 104 patients referred to transvaginal sonography, after which hydrosonography was recommended in order to obtain precise visualization of the endometrium because of suspected endometrial pathology. After hydrosonography, dilatation and curettage with endometrial biopsy were performed in all patients. Biopsy specimens were histologically analyzed. RESULTS The application of contrast sonography described in our research helped diagnose and timely treat as many as 30.8% of patients suffering from premalignant and malignant endometrial disease (23.2% of premalignant and 7.6% of malignant). Discomforts (bleeding and pelvic pain) occurred in 72.1% of patients, out of whom 43.3% had already undergone curettage once or more than once because of the same or similar symptoms, while 27.9% of cases presented for regular control, i.e. they were symptom free. The obtained results clearly emphasized the significance of application of contrast sonohysterography as a method for timely detection of endometrial pathology and its adequate treatment. CONCLUSION The study shows that application of contrast sonohysterography before exploratory curettage significantly facilitates the use of invasive diagnostics and improves accuracy and validity of the obtained results, especially in cases of endometrial focal changes; consequently, it is also possible to achieve positive cost-benefit effect.
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Zamurović M, Srbinović P, Petrović J. [Multiple endometrial polyps in patient undergoing long-term gestagen therapy]. SRP ARK CELOK LEK 2006; 133:438-40. [PMID: 16640190 DOI: 10.2298/sarh0510438z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Endometrial polyps represent a limited focal, circumscribed overgrowth of the endometrium. Their aetiopathogenesis has not been completely explained yet. They are often found in perimenopausal women; during the reproductive period they are less common. We present the case of a 32-year-old patient, who came for a check-up to the Gynaecology and Obstetrics Clinic "Narodni Front" because of irregular bleeding. The patient was subjected to hormonal linestrenol therapy, which she had administered herself, without further consultations with her gynaecologist, during the previous 10 years. Complete diagnostic examinations were performed. Contrast sonohysterography enabled the visualisation of multiple polyps inside the uterine cavity, which were confirmed by histopathological analysis of material obtained via explorative curettage. Histopathological material contained over 30 endometrial polyps. A control check-up after one month, as well as subsequent quarterly check-ups, resulted in normal findings. Analysis of the described case has indicated that the loss of sensitivity of progesterone receptors in endometrial cells is possible if there is a continuous presence of progesterone agonists in circulation, as is true of linestrenol in this case. The loss of sensitivity of progesterone receptors upsets normal hormonal activity during the secretory phase of the menstrual cycle, leading to copious, irregular bleeding. These changes may, however, have even deeper effects. More recent research shows that, if the agent causing the loss of sensitivity of the receptors is present in circulation over a longer time period, changes may also appear at the DNA molecular level, i.e. in the cell genome itself. This, in turn, may lead to the beginning of the process of oncogenesis and the formation of tumourous tissue.
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Machtinger R, Korach J, Padoa A, Fridman E, Zolti M, Segal J, Yefet Y, Goldenberg M, Ben-Baruch G. Transvaginal ultrasound and diagnostic hysteroscopy as a predictor of endometrial polyps: risk factors for premalignancy and malignancy. Int J Gynecol Cancer 2005; 15:325-8. [PMID: 15823120 DOI: 10.1111/j.1525-1438.2005.15224.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- R Machtinger
- Gynecology Oncology Department, Division of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Guven MA, Bese T, Demirkiran F, Idil M, Mgoyi L. Hydrosonography in screening for intracavitary pathology in infertile women. Int J Gynaecol Obstet 2004; 86:377-83. [PMID: 15325856 DOI: 10.1016/j.ijgo.2004.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Revised: 05/07/2004] [Accepted: 05/10/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We evaluated the value of hydrosonography in screening for intracavitary pathologies in infertile patients. METHODS A total of 93 infertile women with suspected intracavitary lesions on transvaginal ultrasonography (TVS) underwent hydrosonography. Specimens obtained either by dilatation and curettage or hysteroscopic resection were compared with findings on TVS and hydrosonography. RESULTS Pathology confirmed the presence of sonographically diagnosed intracavitary lesions in 40 out of 66 (60%) women. The sensitivity, specificity, positive predictive value, and negative predictive value of TVS for the detection of endometrial cavity lesions were 78%, 38%, 61%, and 59%, respectively. Forty-six out of 71 (65%) women who were found to have intracavitary lesions on hydrosonography were pathologically confirmed. The sensitivity, specificity, positive and negative predictive value of hydrosonography in the detection of endometrial cavity lesions were 90%, 40%, 65%, and 77%, respectively. CONCLUSIONS Hydrosonography is a useful procedure in screening for intracavitary pathologies and allows differentiation of intracavitary, endometrial, and submucosal abnormalities.
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Affiliation(s)
- M A Guven
- Department of Obstetrics and Gynecology, Kahramanmaraş Sütcüimam University, Faculty of Medicine, Kahramanmaras, Turkey.
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