Contribution of ultrasound examination in the detection of unexpected uterine and adnexal findings in reconstructive surgery for pelvic organ prolapse

• Published in: Ceská gynekologie Vol. 87; no. 1; p. 13
• Main Authors: Smažinka, Martin, Havíř, Martin, Rušavý, Zdeněk, Vlasák, Pavel, Kovářová, Veronika, Veverková, Adéla, Ismail, Khaled Mostafa, Kališ, Vladimír
• Format: Journal Article
• Language: English
• Published: Czech Republic 01.01.2022
• Subjects: Female; Humans; Hysterectomy; Pelvic Organ Prolapse - diagnostic imaging; Pelvic Organ Prolapse - surgery; Reconstructive Surgical Procedures; Ultrasonography; Uterus - surgery; specialised oncological sonography; malignancy; pelvic organ prolapse; tumor
• ISSN: 1210-7832
• DOI: 10.48095/cccg202213

Objective: Current urogynaecology practice allows preservation of the uterus in pelvic organ prolapse (POP) surgery, thus not reducing oncologic risk. The aim of the study was to evaluate the efficacy of ultrasound (USG) in dia-gnosing unexpected uterine and adnexal pathologies in women referred for POP. Furthermore, the benefit of USG examination by a specialist in gynaecology-oncology ultrasound was assessed. All women after a hysterectomy with or without adnexectomy in the course of a POP surgery at our tertiary centre in 2013-2018 with preoperative USG were enrolled in the study. Women with recurrent uterine bleeding, abnormal cytology, using tamoxifen, or women with already dia-gnosed uterine or adnexal pathology were excluded. 289 women were enrolled in the study - 157 (54.3%) expert USG vs. 132 (45.7%) non-expert USG. Abnormal findings were observed on the cervix in one case (non-expert USG), the endometrium 30 (10.4%) cases - 13 (8.3%) expert vs. 17 (12.9%) non-expert USG, the adnexa three (2.3%) cases (all non-expert USG), and no suspicion of malignancy on myometrium was observed. USG was false negative in four (1.4%) cases - two (1.3%) expert vs. two (1.5%) non-expert USG. Conversely, the examination was false positive in 34 (11.8%) cases - 13 (8.3%) expert vs. 21 (15.9%) non-expert USG. The risk of unexpected uterine or adnexal pathologies in POP surgery was 1.4%. The agreement between USG and histopathological benign, abnormal or malign findings was 87.2%. A sonographer specialized in oncologic sonography is able to reduce the number of false positive findings; however, this does not increase the sensitivity of the ultrasound.