Human Reproduction, Vol 12, 1768-1771, Copyright © 1997 by Oxford University Press
P Vercellini, I Cortesi, S Oldani, M Moschetta, O De Giorgi and PG Crosignani
To verify the reliability of transvaginal ultrasonography in diagnosing
intrauterine disease and in evaluating the operability of submucous myomas
and to determine the feasibility, acceptability and validity of
hysteroscopy for menorrhagia, we performed a prospective 5 year study on
793 women of mean age +/- SD of 41.5 +/- 7.8 years. All the patients
referred for excessive menstrual bleeding with uterine volume <12 week
pregnancy who underwent complete physical examination, transvaginal
ultrasonography and outpatient hysteroscopy with endometrial biopsy were
included in the study. Outpatient hysteroscopy was not completed due to
intolerance or was unsatisfactory due to excessive bleeding in 23 cases
(2.9%). Only 28 women (3.5%) declared they would have refused the procedure
had they imagined the pain involved. One case of pelvic infection was
observed. Compared with hysteroscopy, transvaginal ultrasonography had 96%
sensitivity, 86% specificity, 91% positive predictive value and 94%
negative predictive value in the diagnosis of intrauterine abnormality. The
sensitivity, specificity, positive and negative predictive values of
ultrasonography in identifying submucous myomas operable hysteroscopically
(intramural extension <50%) were respectively 80, 69, 83 and 65% with a
k index of agreement between ultrasonography and hysteroscopy of 0.48.
Thus, considering the good specificity and high negative predictive value,
transvaginal ultrasonography may be suggested as the initial investigation
in menorrhagic patients, limiting hysteroscopy to cases with positive or
doubtful sonographic findings.
ARTICLES
The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia
Clinica Ostetrica e Ginecologica Luigi Mangiagalli, University of Milan, Milano, Italy.
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