“What you see is what you get” abnormal endometrial sonographic findings are sufficient for direct surgical hysteroscopy: Retrospective cohort study

Meir Pomeranz, Zvi Klein, Doron Mulla, Michal Ovadia, Merav Sharvit, Ron Schonman, Yair Daykan, Nissim Arbib

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate the possibility of referring women with uterine polyps larger than 1.5 cm directly to surgical hysteroscopy. Methods: This retrospective cohort study included all women referred to a university-affiliated tertiary medical center for hysteroscopy, with the diagnosis of endometrial polyp, from 01/2013 to 05/2016. Women were referred for surgical hysteroscopy based on TVUS findings. PPV of TVUS for detecting intrauterine polyps was evaluated relating to pathology as gold standard, with sub-group analysis relating to polyp size and other parameters. Results: We selected 1.5 cm as a cutoff size for subgroup analysis of endometrial polyps. PPV of TVUS for the entire cohort of 295 cases eligible for analysis, was 79.3%. TVUS describing polyps ≥1.5 cm had PPV of 92.1%, higher than the PPV for smaller polyps. Among post-menopausal women in this group, PPV was as high as 96.2%. Use of doppler or saline was found to improve PPV in the entire cohort. Indication for performing TVUS did not affect the PPV. Conclusion: TVUS describing polyps ≥1.5 cm may suffice for direct referral of women to surgical hysteroscopy. A personalized approach based on the initial diagnosis may avoid unnecessary invasive procedures for patients.

Original languageEnglish
JournalInternational Journal of Gynecology and Obstetrics
DOIs
StateAccepted/In press - 2021

Keywords

  • hysteroscopy
  • malignancy
  • polyp
  • positive predictive value
  • transvaginal ultrasonography

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