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Use of strict sonohysterographic methods for preoperative assessment of submucous myomas
Francesco Paolo Giuseppe Leone1, Chiara Lanzani, Enrico Ferrazzi
1Department of Obstetrics and Gynecology, Clinical Sciences Institute L Sacco, University of Milan, Milan, Italy. fpgleone@libero.it
Objective:
To assess the diagnostic accuracy of sonohysterography (SHG) and transvaginal sonography versus diagnostic hysteroscopy in preoperative assessment of submucous myomas.
Design:
Prospective pilot study.
Setting:
University hospital outpatient center.
Patient(S):
Forty-eight symptomatic (bleeding, infertility) premenopausal patients with submucous myomas.
Intervention(S):
Preoperative grading of submucous myomas with a strict SHG methodology and standard transvaginal sonography compared with hysteroscopic grading of submucous myoma before hysteroscopic myomectomy.
Main Outcome Measure(S):
SHG and sonographic agreement with hysteroscopic findings.
Result(S):
Forty-eight patients were enrolled (mean age +/- SD = 41 years +/- 10.2). The median duration of SHG was 12 minutes (interquartile range, 9-16). The mean number of submucous myomas was 1 (range, 1-3) per woman. In all cases, a successful SHG was performed, with no, mild, or moderate pain in 38 (79%), 8 (17%), and 2 (4%) patients, respectively. No patients experienced severe pain or vasovagal reaction. All cases were correctly diagnosed by SHG compared with the final hysteroscopic diagnosis (kappa = 1.0; SE = 0.105). Simple transvaginal ultrasound was inaccurate in six cases (kappa = 0.81; SE = 0.103).
Conclusion(S):
Strict and reproducible SHG diagnostic procedures proved to be as effective as hysteroscopy and well tolerated in preoperative grading of submucous myomas.
