Naredi Nikita, Sharma Rajesh, Gurmeet Pranay
ART Centre, Army Hospital Bhopal, Pune, Maharashtra, India.
ART Centre, Army Hospital (R and R), New Delhi, India.
J Hum Reprod Sci. 2021 Oct-Dec;14(4):392-399. doi: 10.4103/jhrs.jhrs_97_21. Epub 2021 Dec 31.
Evaluation of uterine cavity is an important step during investigation of infertile women. The presence of uterine pathology causes impaired receptivity, failed implantation and poor pregnancy outcomes. Various investigative modalities though available; have their limitations. Hysteroscopy considered the gold standard diagnostic modality is invasive; thus, an investigation which could overcome its limitations was required. 3-Dimensional transvaginal sonography (3D TVS), which non-invasively visualizes uterine morphology, registers all three imaging planes simultaneously could be an alternative to hysteroscopy.
To compare 3-D TVS with the gold standard office hysteroscopy for evaluating uterine cavity in sub fertile women.
It was a comparative study carried out at the Reproductive Medicine Centre of a tertiary care hospital.
Over 12 months , 154 women with infertility underwent both hysteroscopy and 3D TVS. The primary outcome was to compare the sensitivity and specificity of 3D TVS in diagnosing endouterine abnormalities and assess if 3-DTVS could replace hysteroscopy for evaluation of uterine cavity.
The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of the 3-D TVS was calculated.
The 3-D TVS had a sensitivity of 88.46% ; specificity of 99.21% for detection of uterine abnormalities with hysteroscopy as gold standard. The Positive Predictive Value was 95.83%; Negative Predictive Value 97.69% and diagnostic accuracy was 97.4%. It was seen that of 24 lesions diagnosed by 3D TVS, hysteroscopy was in agreement with 21 lesions.
3D TVS with advantages of giving better spatial orientation, non-invasive, pain free, can replace hysteroscopy for screening endouterine lesions. With no statistically significant superiority of hysteroscopy over 3D TVS as seen in this study it may be deemed unnecessary in 50% patients having normal uterine cavity.
子宫腔评估是不孕女性检查过程中的重要环节。子宫病变的存在会导致子宫内膜容受性受损、着床失败及妊娠结局不良。虽然有多种检查方法可用，但各有其局限性。宫腔镜检查被视为金标准诊断方法，但具有侵入性；因此，需要一种能够克服其局限性的检查方法。三维经阴道超声检查（3D TVS）可无创显示子宫形态，同时记录所有三个成像平面，可能是宫腔镜检查的替代方法。
比较3D TVS与金标准门诊宫腔镜检查在评估亚生育期女性子宫腔方面的效果。
这是一项在三级医院生殖医学中心进行的对比研究。
在12个月期间，154名不孕女性同时接受了宫腔镜检查和3D TVS检查。主要结果是比较3D TVS诊断子宫内异常的敏感性和特异性，并评估3D TVS是否可替代宫腔镜检查来评估子宫腔。
计算3D TVS的敏感性、特异性、阳性和阴性预测值及诊断准确性。
以宫腔镜检查为金标准，3D TVS检测子宫异常的敏感性为88.46%，特异性为99.21%。阳性预测值为95.83%，阴性预测值为97.69%，诊断准确性为97.4%。在3D TVS诊断出的24个病变中，宫腔镜检查与其中21个病变的诊断结果一致。
3D TVS具有提供更好空间定位、无创、无痛的优点，可替代宫腔镜检查用于筛查子宫内病变。鉴于本研究中宫腔镜检查相对于3D TVS并无统计学上的显著优势，对于50%子宫腔正常的患者，可能无需进行宫腔镜检查。
