Objectives: To compare the diagnostic accuracy of three-dimensional transvaginal ultrasound (3D-US) to office hysteroscopy (OH) in the screening of uterine cavity with normal hysterosalpingography (HSG) findings for subtle endometrial abnormalities before in vitro-fertilization (IVF).
Methods: A prospective cohort cost-modeling study was carried out in a University hospital. We included 120 infertile women with a normal uterine cavity on HSG scheduled for IVF. All cases were evaluated by 3D-US, and the results were compared with OH findings.
Results: OH revealed cavitary endometrial lesions (CLs) in thirty-four women (28.3%). Endometrial polyps were the most common detected lesions (16, 47.1%). 3D-US had 88.2% sensitivity, 96.5% specificity, 90.9% positive predictive value, 95.4% negative predictive value, and 94.2% overall accuracy for CLs. The overall agreement between 3D-US and OH was near-perfect (κ=0.86, 95% CI=0.75-0.96). Irregular menstrual bleeds and prior endometrial procedures were significant predictors for CLs (aOR=24.96, 95% CI=2.71–230.04, P=0.005, aOR=9.16, 95% CI=2.13–39.3, P=0.002, respectively). A selective screening strategy discerning OH to women with these predictors and/or women with abnormal 2D-US would have an NPV of 92.8 % with substantial cost benefits.
Conclusions: In the pre-IVF work up, 3D-US, a non-invasive imaging modality, seems to be nearly comparable to OH. Office hysteroscopy screening prioritizing women with abnormal 2D-US, irregular menstrual periods and/or prior endometrial traumatization could yield a satisfactory cost-effective approach for identifying endometrial lesions.
Three-dimensional ultrasound, multi-slice view, office hysteroscopy, in vitro fertilization, cost modeling
The authors report no conflict of interest.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics
Abdelmagied AM, Kamel MA, Abuelhasan A, Nassr A, Shazly S, Habib DM, Badran E, Ali MK, Abbas AM. Undiagnosed endometrial abnormalities in women with normal hysterosalpingography scheduled for IVF: prospective evaluation of three-dimensional transvaginal ultrasound versus office hysteroscopy. POG in Press. 2020 September; Article 1 [ 18 p.]. Available from: http://ir.uiowa.edu/pog_in_press/. Free full text article.