The value of hysteroscopy and transvaginal ultrasonography in the diagnosis of endometrial hyperplasia: a systematic review and meta-analysis

Abstract

Background The systematic evaluation of the diagnostic value of hysteroscopy and transvaginal ultrasonography for endometrial hyperplasia. Methods A systematic search was performed using China Knowledge Network Database, Wanfang Chinese Database, China Biomedical Literature Database, China Science and Technology Journal Database, PubMed, Medline, The Cochrane Library, and web of science from their dates of inception to December 31, 2017, hysteroscopy and transvaginal ultrasonography were used for the diagnosis of endometrial lesions in those studies. Two researchers screened the literature, extracted data, and evaluated the methodological quality of the included studies independently based on the inclusion criteria. Results A total of 1,354 cases were incorporate into analysis from 9 diagnostic studies meta-analysis showed that the diagnostic accuracy of hysteroscopy for endometrial hyperplasia lesions were: combined sensitivity =0.73 (95% CI: 0.68–0.77), combined specificity =0.92 (95% CI: 0.90–0.93), combined positive likelihood ratio =9.87 (95% CI: 4.08–23.84), combined negative likelihood ratio =0.34 (95% CI: 0.22–0.52), combined diagnostic odds ratio =31.64 (95% CI: 10.34–96.78), area under the summary receiver operating characteristic curve =0.8830. The combined sensitivity of transvaginal ultrasonography for those lesions were 0.69 (95% CI: 0.64–0.74), combined specificity was 0.78 (95% CI: 0.76–0.81), combined negative likelihood ratio was 3.40 (95% CI: 2.46–4.70), combined negative likelihood ratio was 0.41 (95% CI: 0.34–0.50), combined diagnostic odds ratio was 8.94 (95% CI: 5.80–13.79), and area under the summary receiver operating characteristic curve was 0.8180. Conclusions Compared with transvaginal ultrasonography, hysteroscopy have higher sensitivity, specificity, and area under the summary receiver operating characteristic curve for the diagnose of endometrial hyperplasia, hysteroscopy should be selected priority as the auxiliary diagnosis.

Echosonography’s accuracy of intrauterine pathology’s diagnostics in reproductive-age women

“…Проведенный анализ продемонстрировал существенное расхождение ультразвуковых и патоморфологических заключений. У каждой третьей пациентки с ПЭ и ГЭ был установлен неверный диагноз, что согласуется с данными зарубежных исследований, согласно которым чувствительность УЗИ в верификации ПЭ варьирует от 44,8 до 89,6%, а ГЭ -от 58,3 до 69% и свидетельствует об определенной доле гиподиагностики [9,10,[15][16][17][18][19]. Это может быть связано с неспецифичностью УЗ-признаков, как ПЭ, так и ГЭ и ХЭ -наличие гиперэхогенных включений в эндометрии [8].…”

Endometrial Receptivity During the Preimplantation Period: A Narrative Review

“…Histological evaluation involves the analysis of endometrial tissue to assess morphological changes during the WOI, including glandular and stromal development, vascularization, and immune cell infiltration. Although an invasive procedure that can be associated with discomfort and bleeding, endometrial biopsy for histological evaluation is still considered the most reliable method for assessing endometrial receptivity [24].…”

“…Transvaginal ultrasound is particularly advantageous in assessing endometrial receptivity because it provides information on endometrial blood flow and fluid collection. While MRI can also evaluate endometrial thickness and pattern and the presence of uterine and ovarian abnormalities, it is generally more costly and less readily available than ultrasound [24].…”

“…Molecular and genomic approaches are emerging as promising methods for assessing endometrial receptivity. Molecular markers, such as integrins and cytokines, can provide insight into the molecular mechanisms involved in endometrial receptivity [24,26]. Genomic approaches, including gene expression profiling and microRNA analysis, offer comprehensive information on the molecular pathways that regulate endometrial receptivity.…”