Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta‐analysis

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.

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.

“…We found that SISH has a sensitivity of 87.9% and a specificity of 92.2% in the detection of endometrial polyps. Our results are consistent with the previous systematic review conducted by Vroom et al, which reported a sensitivity of 86.5% and specificity of 91.1% for SISH in diagnosis of endometrial polyps [60]. Also, de Kroon et al in their meta-analysis reported that the feasibility of saline contrast hysterosonography was 93% (95% CI: 92-94%) [61].…”

Two‐dimensional transvaginal sonography vs saline contrast sonohysterography for diagnosing endometrial polyps: systematic review and meta‐analysis

“…Vroom et al 40 reported a meta-analysis including five studies published between 1994 and 2017, focusing on women with postmenopausal bleeding and using as gold standards hysteroscopic visualization of the polyp (no histology) or histopathology. They divided their population into two groups, reporting a pooled sensitivity of 86.5% and a pooled specificity of 91.1% for 'polyps diagnosed with histopathology' and of 85.1% and 84.5% for 'polyps seen on hysteroscopy', respectively.…”

Echohysterosalpingography: pros and cons. A systematic review

“…5) после установки катетера вводится трансвагинальный датчик и начинается процесс инстилляции контрастной жидкости дробно. Первая порция в среднем составляет 3-5 мл, с ее помощью контрастируется полость матки для исключения очаговой патологии эндометрия, водящих к деформации полости матки и нередко предшествующих раку эндометрия [32,49]. Длительно протекающие воспалительные процессы приводят к образованию синехий в полости (рис.…”

“…Информация, полученная по скорости движения ультразвукового контраста по маточным трубам, а также время появления контрастирующего вещества в позадиматочном пространстве позволяют судить о моторике маточных труб [26][27][28]. В анатомически полноценной трубе линейная скорость потока контрастного вещества составляет от 60 до 110 см/сек, в маточных трубах с нарушенной проходимостью не превышает 20 см/сек [17,28] ченная подробная анатомическая информация о состоянии полости матки и маточных труб с оценкой ее моторики имеет важное значение в прогнозировании невынашивания беременности [29][30][31][32].…”