Usefulness of saline infusion sonohysterography and feeding artery imaging in endometrial polyp diagnosis

Abstract

Objectives: The aim of this study was to assess the usefulness of sonohysterography with feeding artery visualization using transvaginal sonography to diagnose endometrial polyps. Material and methods:We conducted an observational study of 60 perimenopausal patients referred to the Department of Fetal Medicine and Gynaecology, Medical University of Lodz with abnormal uterine bleeding or suspicion of endometrial pathology based on sonography scan. In all 60 patients transvaginal sonography scan showed a possibility of an endometrial polyp. Of these, 46 underwent saline infusion sonohysterography with sonography visualization of a feeding artery.Pathological examination was performed on material collected during hysteroscopy.Results: Sonography detection of endometrial polyp based on feeding artery visualization had a 40% sensitivity, whereas sonohysterographic polyp detection had a sensitivity of 75% and a specificity of 100%. The positive and negative predictive values of saline infusion sonohysterography in diagnosing endometrial polyps were estimated at 75% and 72% (95% CI: 52-86%), respectively. The combination of sonohysterography and feeding artery imaging in transvaginal sonography was 84% sensitive and 95% specific in detecting endometrial polyps. The positive and negative predictive values were: PPV = 96% and NPV = 89%. Conclusion:Saline infusion sonohysterography with feeding artery visualization may become a standard method in the diagnostics of endometrial polyps in perimenopausal women.

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

“…Furthermore, in our meta-analysis all patients underwent both procedures, which allows a direct comparison of both techniques, instead of a parallel comparison, reducing the risk of bias. Schwärzler (1998) 13 Dijkhuizen (2000) 14 Kamel (2000) 15 de Vries (2000) 16 Epstein (2001) 17Bonnamy (2002) 19 Nanda (2002) 18 Alcazar (2004) 21 Valenzano (2005) 23 Guven (2004) 20 Kelekci (2005) 22 Botsis (2006) 24 Erdem (2007) 25 Yildizhan (2008) 26 Grimbizis (2010) 27 Bingol (2011) 28 Bingol (2011) 29 Soguktas (2012) 30 Vathanan (2016) 32 Aniol (2017) 34 Dogar (2017) 33 Fadl (2018) 35 Moradan (2019) 36 Dueholm 2015 Schwärzler (1998) 13 Dijkhuizen (2000) 14 Kamel (2000) 15 de Vries (2000) 16 Epstein (2001) 17Bonnamy (2002) 19 Nanda (2002) 18 Alcazar (2004) 21 Valenzano (2005) 23 Guven (2004) 20 Kelekci (2005) 22 Botsis (2006) 24 Erdem (2007) 25 Yildizhan (2008) 26 Grimbizis (2010) 27 Bingol (2011) 28 Bingol (2011) 29 Soguktas (2012) 30 Vathanan (2016) 32 Aniol (2017) …”

“…Aniol (2017) 34 Dogar (2017) 33 Fadl (2018) 35 Moradan (2019) 36 Dueholm (2015) 31 Schwärzler (1998) 13 Dijkhuizen (2000) 14 Kamel (2000) 15 de Vries (2000) 16 Epstein (2001) 17 Bonnamy (2002) 19 Nanda (2002) 18 Alcazar (2004) 21 Valenzano (2005) 23 Guven (2004) 20 Kelekci (2005) 22 Botsis (2006) 24 Erdem (2007) 25 Yildizhan (2008) 26 Grimbizis (2010) 27 Bingol (2011) 28 Bingol (2011) 29 Soguktas (2012) 30 Vathanan (2016) 32…”

“…Four were considered as having a high risk of bias since the definition provided was intracavitary lesion without other characteristics or endometrial complex 17,27,32,36 . When analyzing SCSH, two studies 27,34 did not describe how it was performed and were considered to have a high risk of bias, and four 18,32,34,36 were considered as having an unclear risk because the definition of polyp provided by the authors was presence of 'a focal intracavitary lesion'. Taking into account the SCSH failure rate of 5.1% in the 2700 women, we arbitrarily considered as having a high risk of bias those studies that had a failure rate of more than 10% of cases, since a large number of patients in those studies did not undergo both tests 12,17,22,26,34 .…”

“…Twenty-one of the 25 studies were prospective 13-22 , [24][25][26][27][28][29][30][31]33,34,36 and the four remaining studies were retrospective 12,23,32,35 . Among the latter, the examiners performing the TVS and/or SCSH examinations were blinded to histological results in two studies 12,35 and in the other two this issue was not specified 23,32 .…”

“…Concerning the flow-and-timing domain, the time elapsed between the index test and reference standard was not reported in thirteen studies 15,16,19,20,23,24,[26][27][28][32][33][34]36 .…”