A prospective comparison of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding: Clinical implications

Emanuel, Mark Hans; Verdel, Marion J.; Wamsteker, Kees; Lammes, F. B.

doi:10.1016/0002-9378(95)90571-5

Cited by 142 publications

(85 citation statements)

References 8 publications

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“…As previously demonstrated, assessments of the uterine cavity based exclusively on the thickness of the endometrium will not reveal small lesions. When the uterus is not distended, these lesions are compressed and flattened, and they adapt to the shape of the endometrial cavity [8,13]. TVUS did not provide adequate definition of the anatomic relations between detected lesions and the uterine cavity and/or endometrium.…”

Section: Discussionmentioning

confidence: 95%

Three-dimensional sonohysterography for examination of the uterine cavity in women with abnormal uterine bleeding: Preliminary findings

Sconfienza

Lacelli

Caldiera

et al. 2010

Journal of Ultrasound

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KEYWORDSSonohysterography; Three-dimensional sonohysterography; Hysteroscopy; Abnormal uterine bleeding.Abstract Introduction: To compare the diagnostic values of three-dimensional sonohysterography (3DSH), transvaginal ultrasound (TVUS), and 2-dimensional sonohysterography (2DSH) in the work-up of abnormal uterine bleeding (AUB), in particular the ability of each method to identify intracavitary lesions arising from the endometrium or uterine wall. Materials and methods: 24 patients referred for AUB underwent TVUS followed by 2-D and 3-D HS in the same session. Three-dimensional data were acquired with a free-hand technique during maximal distention of the uterus. Within 10 days of the sonographic session, each patient underwent hysteroscopy, which was considered the reference standard. For each of the 3 imaging methods, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Results: Hysteroscopy demonstrated the presence of an intrauterine lesion in 21/24 patients (87.5%). In 3/24 patients hysteroscopy was negative. For TVUS, 2DSH, and 3DSH, sensitivity was 76% (16/21), 90% (19/21), 100% (21/21), respectively; specificity was 100% (3/3), 100% (19/19), 100% (21/21); PPV was 100%, 100%, 100%; NPV was 37%, 60%, 100%; accuracy was 76%, 90%, 100%. Conclusions: 3DSH is more sensitive that 2DSH or TVUS in the detection of intrauterine lesions. If these preliminary results are confirmed in larger studies, 3DSH could be proposed as a valuable alternative to diagnostic hysteroscopy.Sommario Introduzione: Valutare l'impatto diagnostico della Isterosonografia Tridimensionale (ISG 3D) nello studio della cavità uterina in donne con sanguinamento anomalo (SUA) rispetto all'ecografia transvaginale (ETV) e all'isterosonografia bidimensionale (ISG 2D), particolarmente per l'identificazione di neoformazioni a sviluppo endocavitario della superficie endometriale e della parete uterina. Materiali e metodi: Ventiquattro pazienti affette da SUA sono state incluse nello studio. Ciascuna di esse é stata sottoposta ad ETV, ISG e ISG 3D durante la medesima seduta. Le acquisizioni 3D sono state ottenute con tecnica free-hand in fase di massima replezione idrica della cavità. Tutte le pazienti sono state valutate con isteroscopia entro 10 giorni dall'ecografia. Considerando l'esame isteroscopico come reference standard, sono stati calcolati i valori di sensibilità, specificità, valore predittivo positivo (VPP), valore predittivo negativo (VPN) ed accuratezza delle tre metodiche. Risultati: L'isteroscopia ha dimostrato la presenza di lesioni endocavitarie in 21/24 pazienti (87,5% . L'ISG 3D ha consentito una completa identificazione dei rapporti delle lesioni con la cavità uterina e con la parete endometriale. Conclusioni: L'ISG 3D è una metodica con maggiore sensibilità nella definizione delle lesioni della cavità uterina rispetto all'ISG 2D ed all'ETV. Se questi dati preliminari saranno confermati da studi piú ampi, ISG 3D potrebbe essere proposta come alternativa all'ister...

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Section: Discussionmentioning

confidence: 95%

Three-dimensional sonohysterography for examination of the uterine cavity in women with abnormal uterine bleeding: Preliminary findings

Sconfienza

Lacelli

Caldiera

et al. 2010

Journal of Ultrasound

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“…Thus, considering that its high sensitivity and specificity in the detection of intracavitary abnormalities has already been demonstrated (14) , HSC was utilized for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Comparação entre ultrassonografia transvaginal e histerossonografia na avaliação de pacientes com sangramento uterino anormal

Feitosa

Carvalho

et al. 2011

Radiol Bras

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Objective: To comparatively evaluate the effectiveness of transvaginal ultrasonography (TVUS) and sonohysterography (SHG) in the assessment of endometrial diseases in women with abnormal uterine bleeding. Materials and Methods: Cross-sectional study with 30 patients, aged from 29 to 71 years, 21 (70%) of them premenopausal and 9 (30%) postmenopausal. Saline solution (at 9%) was utilized as contrast agent for SHG. The MacNemar test was utilized for comparison of diagnostic studies. Results: Hysteroscopy diagnosed 18 cases (60%) of intracavitary alterations, and 10 polyps (33.3%). TVUS demonstrated 83.3% sensitivity and specificity, and SHG showed 94.4% sensitivity and 91.6% specificity. The MacNemar test showed similar sensitivity (p = 0.500) and specificity (p = 1.000) between TVUS and SHG in the detection of endometrial diseases. In the diagnosis of polyp, SHG showed the highest sensitivity (90.9% vs. 27.3%; p = 0.016) with similar specificity (89.5% vs. 94.7%; p = 1.000). Conclusion: SHG and TVUS present a good predictive value for endometrial diseases in patients with abnormal uterine bleeding. SHG and TVUS present similar sensitivity and specificity in the detection of such diseases, but SHG is more sensitive in the detection of polyps. Keywords: Transvaginal ultrasonography; Sonohysterography; Hysteroscopy; Abnormal uterine bleeding.Objetivo: Avaliar a eficácia da ultrassonografia transvaginal (USTV) e da histerossonografia (HSG) e compará-las na avaliação de alterações endometriais em portadoras de sangramento uterino anormal. Materiais e Métodos: Estudo transversal com 30 pacientes, idade entre 29 e 71 anos, 21 delas (70%) na pré-menopausa e 9 (30%) na pós-menopausa. Utilizou-se solução salina a 0,9% para contraste na HSG. Foi considerado o achado histeroscópico e/ou histopatológico como método padrão. Utilizou-se o teste de MacNemar para comparação dos testes diagnósticos. Resultados: A histeroscopia diagnosticou 18 casos (60%) de alterações intracavitárias, sendo 10 pólipos (33,3%). A USTV apresentou sensibilidade e especificidade de 83,3% e a HSG mostrou sensibilidade de 94,4% e especificidade de 91,6%. O teste de MacNemar evidenciou sensibilidade (p = 0,500) e especificidade (p = 1,000) semelhantes entre a USTV e a HSG para detecção de alterações endometriais. No diagnóstico de pólipo, a HSG apresentou maior sensibilidade (90,9% × 27,3%; p = 0,016), com especificidade semelhante (89,5% × 94,7%; p = 1,000). Conclusão: A HSG e a USTV apresentam boas taxas de predição para doenças endometriais em pacientes com sangramento uterino anormal. A HSG apresenta sensibilidade e especificidade semelhantes às da USTV na detecção dessas doenças, porém apresenta sensibilidade maior para pólipos. Unitermos: Ultrassonografia transvaginal; Histerossonografia; Histeroscopia; Sangramento uterino anormal. AbstractResumo

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“…In the nonpregnant woman with abnormal bleeding, a thin endometrial echo complex (EEC) in combination with an absence of leiomyomas near to the EEC has been associated with normal results of hysteroscopic examination 44 (Class 3). Nevertheless, transvaginal ultrasound is less sensitive than other techniques such as hysteroscopy and contrast sonography (typically saline infusion sonography) at detecting intrauterine lesions, especially polyps 45 (Class 3).…”

Section: Transvaginal Ultrasoundmentioning

confidence: 99%

Acute Uterine Bleeding Unrelated to Pregnancy: A Southern California Permanente Medical Group Practice Guideline

Munro

2013

TPJ

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Acute uterine bleeding unrelated to pregnancy has been defined as bleeding "sufficient in volume as to, in the opinion of the treating clinician, require urgent or emergent intervention." The Southern California Permanente Medical Group updated its guidelines for the management of this condition on the basis of the best available evidence, as identified in a systematic review of the available literature. Given the paucity of studies evaluating this condition, the guidelines, by necessity, include recommendations largely based on opinion or other sources such as case series that are, in general, categorized as low-quality evidence. Medical interventions with single or combined gonadal steroidal agents administered parenterally or orally show promise, but more high-quality studies are needed to better define the appropriate drugs, dose, and administrative scheduling. There is also some evidence that intrauterine tamponade may be useful in at least selected cases. Special attention must be paid to both diagnosing and treating inherited disorders of hemostasis, such as von Willebrand disease, that may otherwise be underdiagnosed in both adolescent and adult women.

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A prospective comparison of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding: Clinical implications

Cited by 142 publications

References 8 publications

Three-dimensional sonohysterography for examination of the uterine cavity in women with abnormal uterine bleeding: Preliminary findings

Three-dimensional sonohysterography for examination of the uterine cavity in women with abnormal uterine bleeding: Preliminary findings

Comparação entre ultrassonografia transvaginal e histerossonografia na avaliação de pacientes com sangramento uterino anormal

Acute Uterine Bleeding Unrelated to Pregnancy: A Southern California Permanente Medical Group Practice Guideline

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