Okonkwo Ifeanyi O, Eleje George U, Obiechina Nworah J, Ugboaja Joseph O, Okafor Chisolum O, Mbachu Ikechukwu I, Obiagwu Hillary I, Okwuosa Ayodele O, Onwusulu Daniel N, Okeke Chukwunwendu F, Ofojebe Chukwuemeka J, Okafor Chidinma C, Ogabido Chukwudi A, Olisa Chinedu L, Okafor Chigozie G
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Awka, Awka, Nigeria.
Acta Radiol Open. 2024 May 10;13(5):20584601241252335. doi: 10.1177/20584601241252335. eCollection 2024 May.
Uterine cavity pathology may affect the endometrium or myometrium, resulting in distortion of the uterine cavity, and is responsible for 2%-5% of infertility. The methods for its assessment usually involve imaging modalities like pelvic ultrasonography, often transvaginal-(TVS), and hysterosalpingography-(HSG), with hysteroscopy-(HSC) as the gold standard. However, HSC is not readily available in resource-poor-settings.
To determine and compare the diagnostic accuracy of TVS and HSG in detecting uterine cavity pathology using HSC as a gold standard.
A cross-sectional analytical study of consenting infertile women for evaluation of the uterine cavity using transvaginal-ultrasonography, hysterosalpingogram, and hysteroscopy. The primary-outcome-measures were the sensitivity, specificity, and accuracy of TVS and HSG in detecting uterine cavity abnormalities using HSG as the gold standard.
Eighty-eight participants were analysed for this study. The lesions confirmed on HSC were intrauterine-adhesions (43.1%), endometrial polyps (14.8%), submucous fibroids (18.2%), intrauterine-septum (13.6%), and cavity distortion (14.8%). The overall sensitivity with TVS was 57.7%, with a specificity of 97.6%, a positive-predictive-value (PPV) of 88.2%, and a negative-predictive-value (NPV) of 88.2%, giving a percentage-accuracy of 88.2%. In comparison, HSG had a sensitivity of 72.1%, a specificity of 99.4%, a PPV of 97.4%, and an NPV of 92.0%, giving an overall accuracy of 92.9%. The detection rates of TVS and HSG in this category were: fibroids (97.7% vs 89.8%; = .0004) and adhesions (73.9% vs 87.5%; = .0002), respectively.
HSG appears to be the superior modality for detection of obliterative uterine cavity pathologies, while TVS is better suited for myometrium and endometrial lesions.
子宫腔病理可能影响子宫内膜或肌层，导致子宫腔变形，占不孕症的2%-5%。其评估方法通常包括盆腔超声检查（通常是经阴道超声，即TVS）和子宫输卵管造影（HSG）等影像学检查方式，宫腔镜检查（HSC）为金标准。然而，在资源匮乏地区不易获得宫腔镜检查。
以宫腔镜检查为金标准，确定并比较经阴道超声和子宫输卵管造影在检测子宫腔病理方面的诊断准确性。
一项横断面分析研究，纳入同意接受经阴道超声、子宫输卵管造影和宫腔镜检查以评估子宫腔的不孕女性。主要观察指标是经阴道超声和子宫输卵管造影以子宫输卵管造影为金标准检测子宫腔异常的敏感性、特异性和准确性。
本研究共分析了88名参与者。宫腔镜检查确诊的病变包括宫腔粘连（43.1%）、子宫内膜息肉（14.8%）、黏膜下肌瘤（18.2%）、子宫纵隔（13.6%）和宫腔变形（14.8%）。经阴道超声的总体敏感性为57.7%，特异性为97.6%，阳性预测值（PPV）为88.2%，阴性预测值（NPV）为88.2%，准确率为88.2%。相比之下，子宫输卵管造影的敏感性为72.1%，特异性为99.4%，PPV为97.4%，NPV为92.0%，总体准确率为92.9%。经阴道超声和子宫输卵管造影在该类别中的检出率分别为：肌瘤（97.7%对89.8%；P = 0.0004）和粘连（73.9%对87.5%；P = 0.0002）。
子宫输卵管造影似乎是检测闭塞性子宫腔病变的更优方式，而经阴道超声更适合检测肌层和子宫内膜病变。
