Two-dimensional transvaginal ultrasound versus sonohysterography for diagnosing endometrial polyps: systematic review and meta-analysis
D Sanin-Ramirez 1 , I Carriles 2 , B Graupera 3 , S Ajossa 4 , M Neri 4 , I Rodriguez 5 , M Á Pascual 3 , S Guerriero 4 , J L Alcazar 2
(1) Department of Obstetrics and Gynecology, Pontifical Bolivarian University, Medellin, Colombia.
(2) Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain.
(3) Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain.
(4) Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Cagliari, Italy.
(5) Biostatistics and Epidemiology Unit, Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain.
Objectives: To compare the diagnostic performance of two-dimensional transvaginal sonography (TVS) and sonohysterography (SHG) for the diagnosis of endometrial polyps in studies that used both of them in the same group of patients.
Methods: Systematic review and meta-analysis. We conducted an extensive search of papers comparing diagnostic performance of TVS and SHG for identifying endometrial polyps, using pathologic analysis as reference standard. This search was performed in Medline (PubMed), Cochrane Library and Web of Science from January 1990 to December 2019. Quality was assessed using QUADAS-2 tool.
Results: 1278 citations were identified, but after exclusions, we only included 25 papers in the meta-analysis. Regarding the studies included, the risk of bias evaluated in QUADS-2 was low for most of four domains, except for flow and timing, which was unclear in thirteen studies. Pooled sensitivity and specificity for TVS were 55.0% (95% confidence interval (CI):46.0%-64.0%) and 91.0% (95% CI=86.0%-94.0%), respectively. For SHG these figures were 92.0% (95% CI=87.0%-95.0%) and 93.0% (95% CI=91.0%-95.0%), respectively. Statistical differences were found when comparing both methods in terms of sensitivity (p<0.001), but not for specificity (p=0.0918). High heterogeneity was found for TVS and moderate for SHG.
Conclusion: Given that, SHG has better diagnostic positive and negative likelihood ratios than TVS; patients with a clinical suspicion of endometrial polyp should undergo SHG if TVS findings are inconclusive. This article is protected by copyright. All rights reserved.
CITA DEL ARTÍCULO Ultrasound Obstet Gynecol. 2020 Jul 30. doi: 10.1002/uog.22161