Uterine cavity assessment in infertile women: comparison of transvaginal sonography and hysteroscopy

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 100; no. 1; pp. 67 - 71
• Main Authors: Loverro, Giuseppe, Nappi, Luigi, Vicino, Mario, Carriero, Carmine, Vimercati, Antonella, Selvaggi, Luigi
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 10.12.2001; Elsevier
• Subjects: Biological and medical sciences; Biopsy; Birth control; Endometriosis - diagnostic imaging; Endometrium - pathology; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Hysteroscopy; Infertility; Infertility, Female - diagnostic imaging; Infertility, Female - pathology; Medical sciences; Ovarian Cysts - diagnostic imaging; Polycystic Ovary Syndrome - diagnostic imaging; Sensitivity and Specificity; Sterility. Assisted procreation; Transvaginal sonography; Tumors; Ultrasonography; Uterus - abnormalities; Uterus - diagnostic imaging; Uterus - pathology; Vagina; Hysteroscopy; Infertility; Transvaginal sonography; Sonography; Human; Female sterility; Method; Female genital diseases; Accuracy; Vaginal route; Echography; Uterine diseases; Female; Endoscopy; Diagnosis; Comparative study
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/S0301-2115(01)00434-1

Objectives: To evaluate the diagnostic accuracy of transvaginal sonography (TVS) in detecting uterine cavity abnormalities in infertile patients, with reference to hysteroscopy as the gold standard method. Study Design: At the Institute of Obstetrics and Gynaecology, University of Bari, 134 infertile women were investigated with both TVS and hysteroscopy. In all cases endometrial biopsy was performed. Sensitivity, specificity, and positive and negative predictive values were calculated for TVS, considering hysteroscopic diagnosis as the gold standard. Statistical analysis was performed by using McNemar test. Results: There was one failed insertion of hysteroscope. Hysteroscopy diagnosed pathological findings in 58 out of 133 cases (44%). TVS was in agreement with 50 of the 58 (86%) of the pathological findings diagnosed at hysteroscopy. As a test for the detection of uterine cavity abnormalities, TVS in comparison with hysteroscopy had 84.5% sensitivity and 98.7% specificity, 98.0% positive predictive value and 89.2% negative predictive value. Conclusions: TVS is able to diagnose polyps, septum and submucous fibroids with quite significant accuracy, while hysteroscopy is indicated for their confirmation and removal. Thus, hysteroscopy provides both diagnostic and therapeutic capabilities, but TVS permits to proceed directly to operative hysteroscopy avoiding the need for a separate diagnostic procedure.