Diagnostic efficacy of gel infusion sonography in post-menopausal bleeding

Abstract Background Our purpose was to evaluate the diagnostic performance of two-dimensional transvaginal ultrasound (2D-TVUS) and gel infusion sonography (GIS) at offline analysis for endometrial characterization compared with real-time evaluation during scanning. One hundred fifty women presented...

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Main Authors: Shimaa Abdalla Ahmed, Hisham Abo-Taleb
Format: Article
Language:English
Published: SpringerOpen 2020-09-01
Series:The Egyptian Journal of Radiology and Nuclear Medicine
Subjects:
Online Access:http://link.springer.com/article/10.1186/s43055-020-00308-w
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author Shimaa Abdalla Ahmed
Hisham Abo-Taleb
author_facet Shimaa Abdalla Ahmed
Hisham Abo-Taleb
author_sort Shimaa Abdalla Ahmed
collection DOAJ
description Abstract Background Our purpose was to evaluate the diagnostic performance of two-dimensional transvaginal ultrasound (2D-TVUS) and gel infusion sonography (GIS) at offline analysis for endometrial characterization compared with real-time evaluation during scanning. One hundred fifty women presented with PMB. At TVUS, endometrial thickness was ≥ 4 mm in 122 (81.3%) women and < 4 mm in 28 (18.72%). Among 122 women with endometrial thickness > 4 mm, GIS was successfully performed in 117 (95.9%). Examinations were stored as video clips for later evaluation (offline analysis) by two less experienced radiologists. Endometrial lesions were classified into four categories: no endometrial abnormality, hyperplasia, polyps, and cancer. Diagnostic efficiency of real-time and offline analysis for diagnosis of each category was calculated and compared, and inter-observer agreement for offline analysis was calculated. Results All patients underwent hysteroscopy and/or hysterectomy. Histopathological results confirmed no endometrial abnormality in (27.3%, 41/150), endometrial hyperplasia in (12.7%, 19/150), endometrial polyps in (17.3%, 26/150), and endometrial cancer in (42.7%, 64/150). Overall diagnostic accuracy of real-time imaging was 89.7% (CI 84–91%)). The highest accuracy 92.7% (CI 88–98%) was seen in the diagnosis of cancer, and polyps 91.5% (CI 86–97%). The lowest accuracy 75% (CI 69–82%) was seen in hyperplasia. Overall diagnostic accuracy of offline analysis was 81%, and it increased to 88% (CI 83–92%) after a restricted analysis of good quality clips. The highest accuracy 90.7% (CI 83–95%) was seen in the diagnosis of polyps, and cancer 90.4% (CI 83–96%). The lowest accuracy 71% (CI 69–75%) was seen in hyperplasia. At offline analysis, the inter-observer agreement was substantial k = 0.77 (CI 71–84) in the evaluation of four endometrial categories after the exclusion of bad quality videos. It was excellent in exclusion of endometrial abnormalities k = 0.85 (0.78–0.90), substantial in the diagnosis of polyps k = 0.71 (0.69–0.88), cancer k = 0.61 (0.61–0.77), and moderate in the diagnosis of hyperplasia k = 0.41 (0.30–0.41). Conclusion Offline 2D analysis with a good image quality has comparable accuracy to a real-time evaluation during scanning in the diagnosis of endometrial lesions. It can increase the accuracy of sonography in ruling out endometrial abnormalities and diagnose non-hyperplastic endometrial pathologies. High NPV and substantial reproducibility can make it an efficient initial screening method in a post-menopausal bleeding.
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spelling doaj.art-216dc0122b25406d9d1f640355d655c02022-12-22T02:18:47ZengSpringerOpenThe Egyptian Journal of Radiology and Nuclear Medicine2090-47622020-09-015111910.1186/s43055-020-00308-wDiagnostic efficacy of gel infusion sonography in post-menopausal bleedingShimaa Abdalla Ahmed0Hisham Abo-Taleb1South Egypt Cancer Institute, Assiut UniversityWomen Health Hospital, Assiut UniversityAbstract Background Our purpose was to evaluate the diagnostic performance of two-dimensional transvaginal ultrasound (2D-TVUS) and gel infusion sonography (GIS) at offline analysis for endometrial characterization compared with real-time evaluation during scanning. One hundred fifty women presented with PMB. At TVUS, endometrial thickness was ≥ 4 mm in 122 (81.3%) women and < 4 mm in 28 (18.72%). Among 122 women with endometrial thickness > 4 mm, GIS was successfully performed in 117 (95.9%). Examinations were stored as video clips for later evaluation (offline analysis) by two less experienced radiologists. Endometrial lesions were classified into four categories: no endometrial abnormality, hyperplasia, polyps, and cancer. Diagnostic efficiency of real-time and offline analysis for diagnosis of each category was calculated and compared, and inter-observer agreement for offline analysis was calculated. Results All patients underwent hysteroscopy and/or hysterectomy. Histopathological results confirmed no endometrial abnormality in (27.3%, 41/150), endometrial hyperplasia in (12.7%, 19/150), endometrial polyps in (17.3%, 26/150), and endometrial cancer in (42.7%, 64/150). Overall diagnostic accuracy of real-time imaging was 89.7% (CI 84–91%)). The highest accuracy 92.7% (CI 88–98%) was seen in the diagnosis of cancer, and polyps 91.5% (CI 86–97%). The lowest accuracy 75% (CI 69–82%) was seen in hyperplasia. Overall diagnostic accuracy of offline analysis was 81%, and it increased to 88% (CI 83–92%) after a restricted analysis of good quality clips. The highest accuracy 90.7% (CI 83–95%) was seen in the diagnosis of polyps, and cancer 90.4% (CI 83–96%). The lowest accuracy 71% (CI 69–75%) was seen in hyperplasia. At offline analysis, the inter-observer agreement was substantial k = 0.77 (CI 71–84) in the evaluation of four endometrial categories after the exclusion of bad quality videos. It was excellent in exclusion of endometrial abnormalities k = 0.85 (0.78–0.90), substantial in the diagnosis of polyps k = 0.71 (0.69–0.88), cancer k = 0.61 (0.61–0.77), and moderate in the diagnosis of hyperplasia k = 0.41 (0.30–0.41). Conclusion Offline 2D analysis with a good image quality has comparable accuracy to a real-time evaluation during scanning in the diagnosis of endometrial lesions. It can increase the accuracy of sonography in ruling out endometrial abnormalities and diagnose non-hyperplastic endometrial pathologies. High NPV and substantial reproducibility can make it an efficient initial screening method in a post-menopausal bleeding.http://link.springer.com/article/10.1186/s43055-020-00308-wPost-menopauseUterine bleedingEndometrial neoplasms
spellingShingle Shimaa Abdalla Ahmed
Hisham Abo-Taleb
Diagnostic efficacy of gel infusion sonography in post-menopausal bleeding
The Egyptian Journal of Radiology and Nuclear Medicine
Post-menopause
Uterine bleeding
Endometrial neoplasms
title Diagnostic efficacy of gel infusion sonography in post-menopausal bleeding
title_full Diagnostic efficacy of gel infusion sonography in post-menopausal bleeding
title_fullStr Diagnostic efficacy of gel infusion sonography in post-menopausal bleeding
title_full_unstemmed Diagnostic efficacy of gel infusion sonography in post-menopausal bleeding
title_short Diagnostic efficacy of gel infusion sonography in post-menopausal bleeding
title_sort diagnostic efficacy of gel infusion sonography in post menopausal bleeding
topic Post-menopause
Uterine bleeding
Endometrial neoplasms
url http://link.springer.com/article/10.1186/s43055-020-00308-w
work_keys_str_mv AT shimaaabdallaahmed diagnosticefficacyofgelinfusionsonographyinpostmenopausalbleeding
AT hishamabotaleb diagnosticefficacyofgelinfusionsonographyinpostmenopausalbleeding