Sonohysterographic imaging of the endometrial cavity

Likelihood ratio of sonohysterographic findings for discriminating endometrial polyps from submucosal fibroids

OBJECTIVES

The purpose of this study was to determine which combination of sonohysterographic features has the highest likelihood ratios (LRs) in discriminating polyps from submucosal fibroids.

METHODS

This retrospective study included 200 consecutive patients who underwent both sonohysterography and a procedure resulting in a positive pathologic diagnosis. A reader, masked to the imaging and pathologic findings, independently reviewed the 200 sonograms and recorded the findings using a standardized checklist for sonographic features on sonohysterography. The features assessed included angle, echogenicity, endometrial-myometrial interface, and vascular pattern, among others. The reader chose one final diagnosis from the list of possibilities, which included normal, hyperplasia, polyp, submucosal fibroid, cancer, adhesions, and clots. Sonographic observations were then compared to pathologic findings.

RESULTS

The LR of 13.4 was achieved for polyps when there was a combination of an intact endometrial-myometrial interface, a single vessel, an acute angle, and homogeneous echogenicity. The highest LR of 27.8 was achieved for submucosal fibroids when the combination of sonographic features included an absent endometrial-myometrial interface, an arborized/multiple vascular pattern, an obtuse angle, and heterogeneous echogenicity.

CONCLUSIONS

A combination of sonographic findings may provide high LRs for discriminating endometrial polyps from submucosal fibroids.