Author/Authors :
Niknejadi, Maryam Department of Reproductive Imaging - Reproductive Biomedicine Research Center - Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran , Haghighi, Hadieh Department of Reproductive Imaging - Reproductive Biomedicine Research Center - Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran , Ahmadi, Firoozeh Department of Reproductive Imaging - Reproductive Biomedicine Research Center - Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran , Niknejad, Fatemeh Department of Reproductive Imaging - Reproductive Biomedicine Research Center - Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran , Chehrazi, Mohammad Department of Epidemiology and reproductive health - Reproductive Biomedicine Research Center - Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran , Vosough, Ahmad Department of Reproductive Imaging - Reproductive Biomedicine Research Center - Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran , Moenian, Deena Department of Reproductive Imaging - Reproductive Biomedicine Research Center - Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Abstract :
Background: Accurate diagnosis of uterine abnormalities has become a core part of the
fertility work-up. A variety of modalities can be used for the diagnosis of uterine abnormalities.
Objectives: This study was designed to assess the diagnostic accuracy of transvaginal ultrasonography
(TVS) in uterine pathologies of infertile patients using hysteroscopy as
the gold standard.
Patients and Methods: This was a cross-sectional study carried out in the Department of
Reproductive Imaging at Royan Institute from October 2007 to October 2008. In this study,
the medical documents of 719 infertile women who were investigated with transvaginal ultrasound
(TVS) and then hysteroscopy were reviewed. All women underwent hysteroscopy
in the same cycle time after TVS. Seventy-six out of 719 patients were excluded from the study
and 643 patients were studied. TVS was performed in the follicular phase after cessation of
bleeding. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value
(NPV) were calculated for TVS. Hysteroscopy served as the gold standard.
Results: The overall sensitivity, specificity, positive and negative predictive values for
TVS in the diagnosis of uterine abnormality was 79%, 82%, 84% and 71%, respectively. The
sensitivity and PPV of TVS in detection of polyp were 88.3% and 81.6%, respectively. These
indices were 89.2% and 92.5%, respectively for fibroma, 67% and 98.3%, respectively for
subseptated uterus and 90.9% and 100%, respectively for septated uterus. Adhesion and
unicornuated uterus have the lowest sensitivity with a sensitivity of 35% and PPV of 57.1%.
Conclusion: TVS is a cost-effective and non-invasive method for diagnosis of intrauterine
lesions such as polyps, submucosal fibroids and septum. It is a valuable adjunctive to
hysteroscopy with high accuracy for identification and characterization of intrauterine
abnormalities. This may lead to a more precise surgery plan and performance.
