Sonohysterography is superior to transvaginal sonography for the diagnostic approach of irregular uterine bleeding in women of reproductive age

PURPOSE: To evaluate and compare the accuracy of transvaginal sonography (TVS) and sonohysterography (SHG) in the investigation of women of reproductive age presenting with irregular uterine bleeding (IUB). METHODS: This prospective study included 104 women presenting with IUB. All patients underwent TVS, SHG, and hysteroscopy, during which endometrial biopsies were obtained and any endometrial mass was treated with hysteroscopic surgery. Statistical analysis was performed by calculating the sensitivity, specificity, and positive and negative predictive values of TVS and SHG in diagnosing endometrial polyp, submucous myoma and all endometrial pathologies (polyp, submucous myoma, endometrial hyperplasia, and endometrial carcinoma) with the histopathological report of the tissues obtained by hysteroscopy serving as the end point for the analysis. RESULTS: The sensitivity, specificity, and positive and negative predictive values, respectively of TVS were 61.2%, 90.9%, 85.7%, and 72.5% for diagnosing endometrial polyps; 75.0%, 92.0%, 63.1%, and 95.3% for diagnosing submucous myomas; and 75.0%, 80.6%, 87.9%, and 63.0% for diagnosing any kind of pathology. The corresponding diagnostic values of SHG were 83.7%, 96.4%, 95.3%, and 86.9% for polyps; 87.5%, 98.9%, 93.3%, and 97.8% for submucous myomas; and 88.2%, 91.7%, 95.2%, and 80.5% for any kind of pathology. CONCLUSIONS: SHG showed superior sensitivity, specificity, and positive and negative predictive values compared with TVS in diagnosing intrauterine lesions in women of reproductive age with IUB.     

Comparison of transvaginal ultrasonography and saline infusion sonography for the detection of intracavitary abnormalities in premenopausal women.

OBJECTIVE: To compare the diagnostic accuracy of transvaginal sonography (TVS) and saline infusion sonography (SIS) for detecting intracavitary abnormalities in premenopausal women with abnormal uterine bleeding. METHOD: Consecutive premenopausal women who underwent hysterectomy for abnormal uterine bleeding were included. All women underwent TVS and SIS before their hysterectomy. The findings at TVS and SIS were compared with the findings of the hysterectomy specimen. Sensitivity, specificity, and likelihood ratios were calculated. RESULTS: The results of 50 patients with abnormal uterine bleeding were evaluated. Histological examination revealed normal endometrial histology in 27 patients, submucous myomas in 13 patients and intracavitary polyps in 10 patients. The sensitivity of TVS in directly visualizing intracavitary abnormalities was 61% for a specificity of 96%. The likelihood ratio of presence of an intracavitary abnormality was 16 and the likelihood ratio of absence of such a finding was 0.41. When defining abnormality at TVS as direct visualization of an intracavitary abnormality or an increased endometrial thickness (cut-off level 5 mm), the sensitivity of TVS was 87% for a specificity of 56%, with corresponding likelihood ratios of 2 and 0.23, respectively. The sensitivity and specificity of SIS was 100% and 85% with likelihood ratios of 6 and 0.0, respectively. No intracavitary abnormality was missed by SIS. CONCLUSION: The diagnostic accuracy of SIS is higher than the accuracy of TVS. A combined approach using endometrial thickness measurement by TVS and, reserving SIS for patients with increased (> 5 mm) endometrial thickness, or endometrium inadequately visualized on TVS, is the optimal method of reducing the hysteroscopy rate.     

Transvaginal sonography of the uterine cavity with hysteroscopic correlation in the investigation of infertility.

This report describes the correlation of hysteroscopic findings with preoperative transvaginal sonography in 200 patients being investigated for infertility. Real-time ultrasound examination was performed on days 7, 14 and 21 in spontaneous ovulatory cycles. Diagnostic hysteroscopy was performed in the subsequent cycle. The abnormalities detected using transvaginal sonography were intrauterine adhesions, submucous fibroids, endometrial polyps, endometritis and a non-specific irregular endometrium. A total of 182 patients were diagnosed correctly to have an abnormality by transvaginal sonography giving a false-positive rate of 5.5%. The sensitivity of transvaginal sonography in detecting endometrial pathology was 98.9% with a positive predictive value of 94.3%. The positive predictive values for specific abnormalities were 98.5% for intrauterine adhesions, 91.7% for submucous fibroids, 91.4% for endometrial polyps, 85.7% for endometritis and 85.7% for irregular endometrium. These data show a strong correlation between findings from transvaginal sonography and hysteroscopy. Transvaginal sonography may be used to detect intrauterine pathology and identify patients in whom hysteroscopy and hysteroscopic surgery are indicated.     

经阴道三维超声诊断子宫内膜病变的临床应用

目的 探讨经阴道三维超声诊断子宫内膜病变的价值。方法 对经阴道二维超声检查疑似宫腔内病变的46例已婚妇女进行经阴道三维超声检查，其结果与宫腔镜及病理相对照。结果 46例患者中子宫内膜增生16例，子宫内膜息肉12例．黏膜下子宫肌瘤9例，子宫内膜癌3例．余6例为正常子宫内膜分泌期改变；二维经阴道超声、三维经阴道超声诊断子宫内膜增生的特异性、敏感性、准确性分别为66．7%、93．7%、76．1%和90．0%、100％、93.5%；诊断内膜．息肉的特异性、敏感性、准确性分别为88．2%，58．3%、80．4%和100%、83．3％、95.7％，结论 三维经阴道超声提高了子宫内膜病变的诊断水平．与二维经阴道超声结合是诊断子宫内膜病变的首选方法。     

Comparison of transvaginal sonography, saline infusion sonography, and hysteroscopy in premenopausal women with abnormal uterine bleeding

PURPOSE: Saline infusion sonography (SIS) is a relatively new technique in the evaluation of abnormal uterine bleeding. We compared the diagnostic accuracy of SIS with that of transvaginal sonography (TVS) in the detection of intracavitary abnormalities in premenopausal women with abnormal uterine bleeding. METHODS: In this prospective study, consecutive premenopausal women who underwent a hysteroscopy for abnormal uterine bleeding also underwent TVS and SIS. The findings at TVS and SIS were compared with the hysteroscopic and histologic findings. Sensitivity, specificity, and likelihood ratios were calculated. Receiver operating characteristic curves were constructed to assess the performance of endometrial thickness measured using TVS. RESULTS: Sixty-two patients were included in the study. TVS demonstrated 60% sensitivity in directly visualizing intracavitary abnormalities and 93% specificity. The likelihood ratio of the presence of an intracavitary abnormality was 8, and the likelihood ratio of the absence of an intracavitary abnormality was 0.43. Defining an abnormality at TVS as direct visualization of an intracavitary abnormality or an endometrial thickness greater than 5 mm, TVS had an 85% sensitivity and a 21% specificity, with corresponding likelihood ratios of 1.1 and 0.71, respectively. For SIS, the sensitivity, specificity, and likelihood ratios of the presence and absence of intracavitary abnormalities were 88%, 95%, 10, and 0.13, respectively. CONCLUSIONS: SIS is more accurate in the diagnosis of intracavitary abnormalities in premenopausal women than is TVS. An approach using endometrial thickness measurement by TVS and reserving SIS for patients who have an endometrial thickness greater than 5 mm or an intracavitary abnormality visualized by TVS would be the most effective method to reduce the number of hysteroscopies.     

The added value of transvaginal sonohysterography over transvaginal sonography alone in women with known or suspected leiomyoma.

OBJECTIVE: To assess whether sonohysterography provides added diagnostic value over transvaginal sonography in patients with suspected or known myomas by comparing diagnostic confidence, interobserver agreement, accuracy, and change in diagnoses when 2 independent observers interpreted transvaginal sonography alone and later interpreted transvaginal sonography and sonohysterography together. METHODS: Hard copy images from 72 women were interpreted independently by 2 sonologists on separate occasions, rating parameters (abnormal uterus, myoma in any location, submucous myoma, classification of location of a submucous myoma with respect to the uterine cavity, myoma remote from the cavity, adenomyosis, and focal and diffuse endometrial lesions) on a scale of 1 to 5 (1 indicated definitely no; 2, probably no; 3, uncertain; 4, probably yes; and 5, definitely yes). Correlation was made with clinical and imaging follow-up, surgery, and pathologic examination. RESULTS: The added information provided by sonohysterography resulted in improved diagnostic confidence for most parameters. Interobserver agreement was markedly improved for the diagnosis and location of submucous myomas and focal endometrial lesions. Sensitivity values for submucous myomas and focal endometrial lesions were 100% and 90% for transvaginal sonography and sonohysterography together and 100% and 70% for transvaginal sonography alone. CONCLUSIONS: We found that sonohysterography does provide additional information over transvaginal sonography alone and is an important adjunct to transvaginal sonography in symptomatic women with known or suspected myomas, particularly before surgical or medical therapy.     

子宫内膜息肉的超声诊断

目的 探讨超声诊断子宫内膜息肉的价值。方法 用经阴道二维黑白超声、彩色多普勒超声、经阴道宫腔超声造影对疑有子宫内膜息肉患者进行检查。结果与手术和病理对照。结果 49例内膜息肉，经手术和病理证实符合率为87．8％(43／49)。误诊6例，误诊率为12．2％(6／49)。内膜息肉的宫腔线弯曲、中断、或消失。内膜间见异常回声团块，二维声像表现为高强回声团块、高回声团块伴蜂窝状大小不等的液性暗区以及中等回声团块。经CDFI检查，血流检出率为93．8％(15／16)。息肉瘤体中可见一条较粗长的血管，从内膜基底层相当于息肉蒂的部位连续到瘤体内。内膜息肉在宫腔超声造影中见息肉呈圆形、笋尖状等多种形态，隐藏在内膜间的小息肉，在造影中，内膜被液体推开时．则可显露无疑。结论 经阴道超声检查能有效地对子宫内膜息肉进行诊断．结合彩色多普勒超声和宫腔超声造影，可提高诊断符合率。诊断内膜息肉应与内膜增生过长、粘膜下肌瘤等疾病鉴别。     

子宫粘膜下肌瘤的阴道超声诊断分析

目的：评价经阴道超声诊断子宫粘膜下肌瘤的价值.方法：回顾性分析86例患者的经阴道超声检查结果,并与手术病理结果对照.结果：阴道超声诊断准确率85%,8例误诊为子宫内膜息肉,4例误诊为子宫内膜增厚,1例误诊为子宫内膜癌.结论：阴道超声对子宫粘膜下肌瘤有较高的临床诊断价值.     

Comparative study of transvaginal sonography and hysteroscopy for the detection of pathologic endometrial lesions in women with postmenopausal bleeding.

Dilatation and curettage is used as the "gold standard" for diagnosing pathologic endometrial lesions in women with postmenopausal bleeding. In this group of women, about 10% have an endometrial cancer and an additional 20% have some other endometrial abnormality. However, some abnormalities, such as endometrial polyps and submucous fibroids, are difficult to diagnose by dilatation and curettage. In such cases, combining transvaginal sonography with hysteroscopy may be of value. This study compared the use of transvaginal sonography and hysteroscopy for evaluation of the uterine cavity in women with postmenopausal bleeding. The study included 51 women, 39 of whom had an abnormally thick ( > 4 mm) endometrium as measured by transvaginal sonography, and 35 of 39 had an abnormal appearance at hysteroscopy. The sensitivity and specificity for the measurement of endometrial thickness using transvaginal sonography to diagnose an endometrial abnormality were 100% and 75%, respectively. The corresponding figures for hysteroscopy were 97% and 88%. In all women with an endometrial thickness of 8 mm as measured by transvaginal sonography, hysteroscopy is identified as an abnormality. The study indicates that transvaginal sonography reveals an endometrial thickness of > or = 8 mm and the histopathologic diagnosis after dilatation and curettage is atrophic endometrial polyp or submucous myoma.     

Transvaginal hysterosonography in the evaluation of small endoluminal masses.

Transvaginal sonography is highly sensitive for detecting endometrial mass lesions, but it is nonspecific. Biopsies performed on patients with abnormal findings seen on TVS often are negative. We performed transvaginal hysterosonography prospectively on 48 consecutive patients with endometrial thickness demonstrated on TVS to be between 5 and 10 mm to assess whether this technique would be useful in the evaluation of such patients. TVHS is a simple, painless technique that is performed by placing a small catheter into the endometrial canal and infusing a small amount of saline solution under sonographic visualization. Of 48 suspected lesions, TVHS confirmed only 19 endoluminal masses: 11 fibroids and eight polyps. Polyps tended to be homogeneously echogenic and to have a pedunculated attachment to the uterine wall without interruption of the endometrial lining. Fibroids showed more heterogeneous echogenicity and had a more sessile attachment. Four patients in our series had false-negative biopsy results prior to having had endometrial mass lesions depicted on TVHS. TVHS may prevent unnecessary biopsies in those patients who appear to have abnormalities on TVS. By depicting the nature of the attachment of endoluminal masses to the uterine wall more clearly, TVHS also may help direct subsequent biopsy procedures.     

实时灰阶超声造影在宫腔异常回声鉴别诊断中的应用

目的探讨实时灰阶超声造影技术对宫腔异常回声鉴别诊断的应用价值。方法以意大利Bracco公司生产的声诺维（SonoVue）为造影剂,对27例宫腔异常回声者行实时灰阶超声造影检查,观察造影剂在病灶内充盈方式及增强程度,以手术病理结果为标准,分析比较不同病因的宫腔异常回声造影显像特点。结果27例宫腔异常回声的组织病理结果分别为子宫内膜息肉、子宫黏膜下肌瘤、子宫内膜癌、不全流产宫腔残留和宫腔黏连,各种病变的超声造影表现明显不同。结论实时灰阶超声造影技术能够较准确地鉴别诊断宫腔异常回声。     

经阴道超声与宫腔注液造影评价宫腔内病变

目的　评价经阴道超声与宫腔注液造影对宫腔内病变的诊断价值。方法　应用经阴道超声与宫腔内注液造影结合检查月经不规则妇女２０ 例,宫腔造影插管采用更细、更方便的专用宫腔造影管,造影剂用无菌生理盐水。结果　粘膜下肌瘤７ 例,呈等回声或低回声、无蒂、基底较宽,基底处内膜强回声线中断;内膜息肉６ 例,呈中强回声,多有蒂,基底处内膜强回声线无中断;子宫内膜癌２ 例,为中强回声,基底宽广,形态、边缘不规则,回声不均;５ 例宫腔内未见病变。与最后诊断符合者１９ 例（１９／２０） 。结论　经阴道高频超声与宫腔注液造影检查是一项简便、准确、无创的宫腔内病变的诊断方法。     

经腹及经阴道超声、宫腔超声造影和宫腔镜诊断宫内病变

目的 评价经腹、经阴道超声及官腔超声造影、官腔镜对宫内病变的诊断价值。方法 常规经腹部、经阴道超声及生理盐水灌注官腔后经阴道超声观察宫内病变，官腔镜检查治疗宫内病变。结果 88例经腹超声，45例经阴道超声，39例官腔超声造影，23例行官腔镜检查治疗，数种方法结果比较：官腔超声造影和官腔镜的敏感性、准确性和阳性预测值最高，分别为94．29％、90．24％、94．29％和95、65％、91、67％、95．65％，两者差异无显著性意义。结论 经阴道超声、官腔超声造影是诊断官腔内病变的一种简便、经济、无痛苦无损伤、诊断率高的方法。     

Sonohysterography for distinguishing endometrial thickening from endometrial polyps in postmenopausal bleeding.

Sonohysterography, or sonographic uterine cavity visualization by uterine cavity distension, may help to distinguish true endometrial thickening from other intracavitary pathological conditions, assuming the same sonographic appearance. We examined 1.5 women with a thickened endometrium (range 10-25 mm) in sonography performed for postmenopausal bleeding. Sonohysterography revealed a polypoid structure in seven women, a normal uterine cavity in four women, and a thickened endometrium in four women. All the women underwent hysteroscopic evaluation of the uterine cavity. Hysteroscopy confirmed the sonohysterographic findings in 14 women (93.3%). Hysteroscopic resection of the polypoid structure was performed while the other patients underwent diagnostic curettage. Histological examination of the seven polypoid structures revealed benign endometrial polyps in six patients, and one pedunculated submucous fibroid. In the patients undergoing diagnostic curettage, histological examination revealed three cases of glandular hyperplasia, one of cystic (atrophic) hyperplasia, and one of papillary endometrial adenocarcinoma. Two cases were inadequate for diagnosis. The advantage of sonohysterography in distinguishing endometrial thickening from intracavitary polyps or fibroids was clearly demonstrated. This technique can help in tailoring the correct treatment in various conditions presenting as postmenopausal bleeding.     

Saline contrast sonohysterography in the preoperative assessment of benign intrauterine disorders.

OBJECTIVES: To assess the value of saline contrast sonohysterography (SCSH) in the preoperative evaluation of benign intrauterine lesions. DESIGN: Patients presenting with abnormal bleeding related to benign uterine pathologies and scheduled for surgical treatment were prospectively enrolled in a study conducted between 1 January 1996 and 31 December 1997. SCSH was first carried out with the intention of establishing further surgical management (hysterectomy or hysteroscopy). The end point of the study was to compare the surgical option ultimately carried out with the one decided after SCSH. In addition, size and location of intrauterine lesions determined by SCSH were compared with those issued from surgical records. Similarly, pathologic results were juxtaposed to SCSH diagnosis. Statistical analysis used non-parametric and correlation tests. RESULTS: Two hundred and thirty-three patients were included in the study, 39.5% of whom were postmenopausal. SCSH was consistently effective in the choice of the best surgical method, because no hysterectomy was required when an operative hysteroscopy was indicated on SCSH data. Similarly, only one patient treated by hysterectomy (5.8%) could have undergone a more conservative approach. But this patient had a genital prolapse, and thus hysterectomy was a part of the treatment. SCSH correlated well with surgery for the location and size of intrauterine lesions (P < 0.001). SCSH was accurate in the diagnosis of polyps and submucous myomas (sensitivity 85.7%, specificity 95.4%). CONCLUSIONS: SCSH appears an important tool for preoperative assessment of benign intrauterine pathologies. It should be used in the selection of patients that should be scheduled for an operative hysteroscopy.     

Comparison of sonography,sonohysterography, and hysteroscopy for evaluation of abnormal uterine bleeding.

We compared transvaginal sonography, sonohysterography, and diagnostic hysteroscopy in the evaluation of abnormal uterine bleeding, Sixty-eight women 40 or older with abnormal uterine bleeding were assigned to undergo either transvaginal sonography or sonohysterography. All subjects then had diagnostic hysteroscopy and endometrial biopsy. Patients with abnormal findings underwent operative hysteroscopy or definitive therapy. Transvaginal sonography, sonohysterography, and diagnostic hysteroscopy revealed a sensitivity of 95%, 90%, and 78%, and a specificity of 65%, 83%, and 54%, respectively. The average cost for transvaginal sonography of sonohysterography was $195 and the cost for diagnostic hysteroscopy was $675. Transvaginal sonography and sonohysterography are cost-effective alternatives and more sensitive diagnostic tests than office diagnostic hysteroscopy.     

经阴道超声结合宫腔镜检查对绝经后子宫出血的诊断价值

目的探讨经阴道超声(TVS)结合宫腔镜(HSC)检查在绝经后子宫出血中的诊断价值。方法回顾性分析2007年6月至2010年6月应用TVS结合HSC检查绝经后子宫出血230例,术中行定位取材或诊断性刮宫。结果 TVS诊断绝经后子宫出血病人宫腔内病变的符合率为71.74%,TVS结合HSC的诊断符合率为88.26%。结论 TVS结合HSC对发现绝经后子宫出血病人宫腔内病变具有一定的价值。     

Sonohysterography for ultrasonographic evaluation of tamoxifen-associated cystic thickened endometrium.

Most menopausal patients with breast cancer receive tamoxifen therapy. In these patients, TVS may show thickened, irregular cystic endometria. For better visualization of these patients' uterine cavities, we performed transvaginal sonohysterography. During vaginal ultrasonography, sterile saline was introduced by transcervical 8 French Foley catheter into the uterine cavity of 20 women who were referred with tamoxifen-associated cystic thickened endometria. In eight women, transvaginal sonohysterography provided the means to diagnose occult, free-floating endometrial polyps, whereas in 12 women, the fluid contrast augmented the diagnosis of an irregular cystic endometrial-myometrial junction. All 20 patients underwent diagnostic hysteroscopy: eight polyps, none of which were malignant, were confirmed and removed by hysteroscopic resection. Of the remaining 12 patients with an irregular endometrial-myometrial junction, endometrial curettage showed no significant pathologic findings. Transvaginal sonohysterography seems to enhance the differentiation between endometrial polyps that should be resected by operative hysteroscopy and an abnormal endometrial-myometrial junction that may benefit from biopsy sampling only.     

经阴道三维超声对不孕不育患者宫腔病变的诊断价值

目的探讨三维超声在不孕不育患者宫腔病变中的诊断价值。 方法选取2017年1月至2018年12月在南京医科大学第一附属医院生殖医学中心的不孕不育患者行经阴道三维超声检查，将428例诊断为不同类型宫腔病变患者的三维超声结果与宫腔镜或病理组织学结果进行比较分析，以宫腔镜或病理组织学结果为"金标准"，采用四格表计算三维超声诊断各类宫腔病变的敏感度、特异度、阳性预测值、阴性预测值及准确性。 结果三维超声诊断宫腔病变患者428例，其中包括宫腔粘连235例（54.9%），子宫内膜息肉153例（35.7%），子宫黏膜下肌瘤40例（9.4%）。将428例患者的三维超声结果与宫腔镜或病理组织学结果相比较，诊断结果一致为404例（94.4%），误诊24例（5.6%），其中，宫腔粘连误诊14例，子宫内膜息肉误诊7例，子宫黏膜下肌瘤误诊3例。三维超声与宫腔镜或病理组织学结果相比，其诊断各种类型宫腔病变的准确性分别为：宫腔粘连96.73%，子宫内膜息肉96.96%，子宫黏膜下肌瘤98.83%。 结论三维超声对各种宫腔病变有较高的诊断准确性，可作为不孕不育患者排除宫腔病变的首选检查方法。     

经阴道超声和超声子宫造影对子宫腔内病变诊断的比较

目的：评价经阴道超声和超声子宫造影对子宫腔内病变的诊断作用。方法：经阴道超声诊断官腔内异常的44例患者，行超声子宫造影检查，以宫腔镜和病理结果为标准，计算两种方法诊断子宫内膜息肉、黏膜下肌瘤、内膜病变的敏感性、特异性、准确性、阳性预测值和阴性预测值。结果：44例患者，经阴道超声诊断内膜息肉、黏膜下肌瘤、内膜病变的敏感性、特异性、准确性分别为65％、96％、82％；94％、96％、95％；100％、67％、77％；超声子宫造影诊断内膜息肉、黏膜下肌瘤、内膜病变的敏感性、特异性、准确性分别为85％、100％、93％；100％、85％、91％；100％、98％、98％。结论：与传统的经阴道超声相比，超声子宫造影对子宫腔内病变的诊断有很高的敏感性和特异性，是一种简便易行、疼痛少，无合并症的诊断方法。