(Ultrasound Review) Spanish researchers compared transvaginal color Doppler ultrasound (TVCD) with sonohysterography (SHG) for endometrial polyps and found the diagnostic performance to be similar.
In the June issue of Journal of Ultrasound in Medicine, Dr Juan Luis Alcázar and colleagues at Clínica Universitaria de Navarra in Pamplona noted that polyps are a common cause of abnormal uterine bleeding. To determine which was superior, a prospective study of 51 women was performed to fully assess TVCD and SHG. All of the women included for study showed indications of endometrial polyps either clinically or on grayscale ultrasound.
A polyp was diagnosed sonographically when a focal area of increased echogenicity was demonstrated within the endometrium. On TVCD, "a single arterial vessel penetrating the endometrium from the myometrium" was identified.
Measurement of endometrial thickness on transvaginal ultrasound has been proven to be a useful method for demonstrating endometrial disease. TVCD enables appraisal of endometrial blood vessels and both TVCD and SHG increase the specificity of grayscale sonography.
"In the case of endometrial polyps, TVCD can predict histologic atypia," according to the authors.
Comparison with hysteroscopy and endometrial biopsy showed that the sensitivity of TVCD for detecting endometrial polyps was 95%, and specificity was 100%, while sensitivity and specificity of SHG was 80%.
"This could indicate that SHG could not be necessary when a clear pedicle is identified on a color Doppler examination," they recommended.
Two polyps were missed on TVCD because no pedicle was shown on color Doppler sonography. However, at SHG and hysteroscopy, both modalities revealed an endometrial polyp in each patient. "In these two cases, the endometrium had a homogeneous echogenic appearance," they reported.
The researchers observed that "SHG is superior to TVCD for polyp location. Should this location have clinical relevance, then SHG should be performed systematically." However, in their opinion, knowing the location of polyps prior to hysteroscopy is not important from a surgical point of view.
Transvaginal Color Doppler Sonography versus Sonohysterography in the Diagnosis of Endometrial PolypsJuan Luis Alcázar, et. Al.
Department of obstetrics and gynecology, Clínica Universitaria de Navarra, Pamplona, Spain.
J Ultrasound Med 2004; 23:743-748
By Ultrasound Review
August 3, 2004
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