Article
Authors: Ahmed M Abdelmagied (Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt) , Momen A Kamel (Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt) , Ahmed Abuelhasan (Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt) , Ahmed Nassr (Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt) , Sherif Shazly (Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt) , Dina M Habib (Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt) , Esraa Badran (Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt) , Mohammed K. Ali (Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt) , Abbas M Abbas (Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt)
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.
Keywords: Three-dimensional ultrasound, multi-slice view, office hysteroscopy, in vitro fertilization, cost modeling
How to Cite: Abdelmagied, A. M. , Kamel, M. A. , Abuelhasan, A. , Nassr, A. , Shazly, S. , Habib, D. M. , Badran, E. , K. Ali, M. & Abbas, A. M. (2020) “Undiagnosed endometrial abnormalities in women with normal hysterosalpingography scheduled for IVF: prospective evaluation of three-dimensional transvaginal ultrasound versus office hysteroscopy”, Proceedings in Obstetrics and Gynecology. 10(1). doi: https://doi.org/10.17077/2154-4751.1498