Diagnosis of endometrial pathologies: transvaginal sonography versus hysteroscopy
Keywords:Abnormal uterine bleeding, Hysteroscopy, Transvaginal ultrasonography
Background: Abnormal uterine bleeding (AUB) constitutes 69% of all gynecological complaints in the peri- and postmenopausal age groups. The aim of present study was to compare the accuracy of transvaginal sonography and hysteroscopy in diagnosing intracavitary pathologies in women with abnormal uterine bleeding.
Methods: A total of 303 premenopausal women with abnormal uterine bleeding who admitted to the gynecology outpatient clinic of the Istanbul Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey, between April 2010 and July 2015, and received hysteroscopy, were evaluated retrospectively. The collected data were assembled from the computerised database. All patients underwent pelvic examination, transvaginal ultrasonography, office hysteroscopy and hystopathologic evaluation. Patients with normal appearing uterine cavities on hysteroscopy additionally underwent full curettage. The pathology reports were considered to be the definitive diagnoses of patients. Transvaginal ultrasonography and office hysteroscopy findings were compared with the pathological reports and the sensitivity, specificity, positive and negative predictive values, accuracy values and likelihood ratios of office hysteroscopy and transvaginal ultrasonography were calculated for the detection of endometrial abnormalities.
Results: Endometrial polyps were the most commonly identified pathology with a rate of 77.56%. The sensitivity, specificity, positive and negative predictive values of transvaginal sonography for diagnosing endometrial pathologies were 77%, 32%, 75% and 32%, respectively. The same values for hysteroscopy were 93%, 44%, 88% and 48% respectively. Transvaginal sonography had a sensitivity of 20% with a specificity of 4% for submucous myomas. The sensitivity, specificity, positive and negative predictive values of hysteroscopy for submucous myomas when compared to histopathology were 100% for all.Conclusions: The diagnostic accuracy of office hysteroscopy for focal lesions such as polyps or submucous myomas is higher than the accuracy of transvaginal ultrasonography. Due to its high diagnostic accuracy, lower complication rate and the ability to obtain direct biopsy specimens while providing simultaneous treatment, we believe that hysteroscopy will retain its place as the gold standard procedure for the investigation of endometrial pathologies.
Emanuel MH, Verdel MJC, Stas H. An audit of true prevalence of intrauterinepathology: the hysteroscopical findings controlled for patient selection in 1202 patients with abnormal uterine bleeding. Gynaecol Endosc. 1995;4:237-41.
Creasman W.T. Endometrial cancer: incidence, prognostic factors, diagnosis, and treatment. Semın Oncol. 1997,24,S1-140-50.
Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13.
Williams CD, and Marshburn PB. A prospective study of transvaginal hydrosonography in the evaluation of abnormal uterine bleeding. Am J Obstet Gynecol. 1998;179:292-8.
Farquhar C, Ekeroma A, Furness S, Arroll B. Systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Acta Obstet Gynecol Scand. 2003;82:493-504.
de Vries LD, Dijkhuizen FP, Mol BW, Brölmann HA, Moret E, Heintz AP. Comparison of transvaginal sonography, Saline infusion Sonography and Hysteroscopy in premenopausel women with abnormal uterine bleeding. J Clin Ultrasound. 2000;28(5):217-23.
Goyal BK, Gaur I, Sharma S, Saha A, Das NK. Transvaginal sonography versus hysteroscopy in evaluation of abnormal uterine bleeding. Med J Armed Forces India. 2015;71(2):120-5.
Widrich T, Bradley LD, Mitchinson AR, Collins RL. Comparison of saline infusion sonography with Office hysteroscopy for the evaluation of the endometrium. Am J Obstet Gynecol. 1996;174(4):1327-34.
Garuti G, Sambruni I, Colonnelli M, Luerti M. Accuracy of hysteroscopy in predicting histopathology of endometrium in 1500 women. J Am Assoc Gynecol Laparosc. 2001;8(2):207-13.
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(1):143-5.
Veena BT, Shivalingaiah N. Role of transvaginal sonography and diagnostic hysteroscopy in abnormal uterine bleeding. J Clin Diagn Res. 2014;8(12):OC06-8.
Birinyi L, Daragó P, Török P, Csiszár P, Major T, Borsos A, Bacskó G. Predictive value of hysteroscopic examination in intrauterine abnormalities. Eur J Obstet Gynecol Reprod Biol. 2004;115(1):75-9.
Vercellini P, Cortesi I, Oldani S, Moschetta M, De Giorgi O, Crosignani PG. The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia. Hum Reprod. 1997;12:1768-71.
Mahmud A, Smith P, Clark J. The role of hysteroscopy in diagnosis of menstrual disorders. Best Pract Res Clin Obstet Gynaecol. 2015;29(7):898-9.