C. Lanzani

Use of strict sonohysterographic methods for preoperative assessment of submucous myomas

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.

Two-dimensional HyCoSy with contrast tuned imaging technology and a second-generation contrast media for the assessment of tubal patency in an infertility program

OBJECTIVE To compare the efficiency of hysterosalpingo-contrast-sonography performed with air and saline (Hydro-HyCoSy) with HyCoSy performed with contrast media (SonoVue) and contrast-tuned imaging technology (CnTI-SonoVue-HyCoSy) considering hysterosalpingography (HSG) and laparoscopy (LPS) as reference tests and to evaluate the learning curve of this procedure. DESIGN Retrospective study. SETTING Reproductive unit of a university hospital. PATIENT(S) Forty-two infertile female patients. INTERVENTION(S) HyCoSy were performed with a 2.4-mm intrauterine catheter. Patients underwent HSG or LPS as controls. MAIN OUTCOME MEASURE(S) Mean age, sensitivity, specificity, positive and negative predictive value, kappa value, and diagnostic accuracy were evaluated for statistical analysis. RESULT(S) Sensitivity, specificity, and positive and negative predictive values of Hydro-HyCoSy were 91%, 71%, 55%, and 95%, respectively, while for CnTI-SonoVue-HyCoSy they were 87%, 84%, 69%, and 94%. The diagnostic accuracy of Hydro-HyCoSy and of CnTI-SonoVue-HyCoSy were 77% and 85%, with a Cohens kappa of 0.52 and 0.66, respectively. CnTI-SonoVue-HyCoSy does not require a learning curve period. CONCLUSION(S) CnTI-SonoVue-HyCoSy is more accurate than Hydro-HyCoSy for the assessment of fallopian tubes. The very high normal predictive value of Hydro-HyCoSy suggests that this procedure could be performed as a screening examination, whereas CnTI-SonoVue-HyCoSy could be used as a second-step technique.

Sonohysterographic endometrial sampling and hysteroscopic endometrial biopsy: a comparative study

To compare the quantity and quality of endometrial tissue sampled at saline contrast sonohysterography (SCSH) with that obtained by directed endometrial biopsy by operative hysteroscopy in patients with diffusely thickened and/or inhomogeneous endometrium at SCSH. A secondary aim was a comparison of the extent of procedure‐related pain.

Asymptomatic endometrial polyps in postmenopausal women: are they an indication for surgical removal?

Purpose:  To compare demographic, sonographic, and outcome data of postmenopausal patients with asymptomatic endometrial polyp, surgically treated or not treated.

OC045: Prognostic markers of malignancy at sonohysterography in post‐menopausal patients with post‐menopausal bleeding and thickened endometrium at transvaginal sonography

negative values. The aim was to determine the number of acquisitions needed to detect micturition and to calculate precise diuresis. Methods: Prospective observational study of bladder acquisions with 3D and volume measurement with VOCAL, using a 4–7 RAB volumetric transducer in a Voluson 730 Expert. The acquisition performed in High 1 definition, 30◦, with the image centered in the bladder avoiding shadows. Unselected, 126 normal singleton pregnancies from 20 to 38 weeks were included. The operators were asked to perform 2 to 5 acquisitions with a 3 to 5 minute interval during normal scan, without taking into account if the bladder subjectively growed. The volume was calculated manually with 30◦ rotation, after the scan. Results: 74, 42, 8 and 2 pregnancies had 2, 3 4 and 5 acquisitions. When 2 acquisitions, the mean time interval was 4 : 33 (min : sec), range 00 : 13–20 : 16. From these, 11% (8) had decreasing volumes, not being possible to measure diuresis. For those cases with three acquisitions, the mean time interval from the first to the last was 7 : 33, with 10% (4) cases in which all volumes were decreasing, being not possible to measure diuresis. In ten cases with 4 or 5 acquisitions there were always two growing phases that allowed diuresis measurement. The mean time interval from the first to the last acquisition was 10 : 06, range 5 : 31–19 : 04. Only two fetuses had two negative diuresis and these were always consecutive, suggesting that micturition may take some time. Conclusion: At least 4 bladder acquisitions in a time interval of 10 minutes are needed to detect micturition and perform precise diuresis calculations. This has to be considered for future fetal diuresis studies.

Cervical cerclage after hysteroscopic metroplasty

Purpose:  The objective of the study is to evaluate the role of cervical cerclage after hysteroscopic metroplasty.

P13.22: Conservative sonographic-based management of bilateral asynchronous adnexal torsion with laparoscopic detorsion and sparing of twisted ischemic adnexa: a case report

lymphoma and 1 was with non tumor necrotic tissue in a vulva mass, 1 was with fibroelastosis. Of 12 patients with ascites, 7 had tumor cells negative results from ascites cytological examination before biopsy but the positive diagnosis of all the nine was obtained from tissue biopsy. Except 1 case with abdominal cavity hemorrhage, no complications were found. Non ̈ Cnecrotic tumor tissue appeared pearly or misty gray, moister bandage-like continuous. The necrotic tissue is pearl gray, drier and scatter or to be broken. The abdominal wall muscular tissue was reddish moister and elastic. Conclusions: US-guided tumor biopsy with core needle in gynecoid pelvic cavity possesses significant guidance for choosing treatment modalities or operation routs. The US-guided biopsy with 18 G needle is safe and can obtain satisfactory samples, however, it is suggested that the puncture times in 1 case be decreased as least as possible.

P06.09: Sonohysterography with endometrial sampling in the pre‐operative assessment of submucous myomas

Case reports: 1) A 38 year old woman was investigated for abnormal uterine bleeding on 5 days of postmenstrual period. Past history said two times cesarean section about 5 years ago. Transvaginal sonographic examination revealed defect that measured 9 to 16 mm in maximal diameter surrounded endometrial lining in previous cesarean scar. 2) A 28 year old woman visit in our department due to abnormal uterine bleeding. She delivered a male baby by cesarean section two years ago. After then she suffered from vaginal bleeding on 7 days of postmenstrual period. Also transvaginal sonographic examination revealed defect that measured 14 to 16 mm in maximal diameter in previous cesarean scar with mobile, dispersible echogenic material that had the typical appearance of old blood. Currently no simple and adequate method exists for the treatment of abnormal bleeding related to these cesarean section defects. But in case of desiring future pregnancy, precise counseling for expectable complications should be given and repair of uterine defect could be considered to these patients.

Endometrial sampling during sonohysterography (SHGes)

Purpose:  To assess the diagnostic accuracy of sonohysterography (SHG) and endometrial sampling during SHG (SHGes) compared to traditional hysteroscopy and biopsy.

P15.06: Accuracy of a sonographic based triage with endometrial sampling during saline contrast sonohysterography in pre‐ and post‐menopausal women with abnormal uterine bleeding

and uterine and 10 mm shell myometrial 3D-PDA indices VI (vascularization index), FI (flow index) and VFI (vascularization flow index) were calculated. Signal attenuation in 3D-PDA was evaluated by categorizing the patients into two subgroups according to the distance to the center of the endometrium. The results were compared with a complete surgical staging. Results: A deep myometrial invasion was present in 23 patients. Of the color Doppler indices, the uterine artery RI and PI were statistically significantly lower in the group with deep invasion (P = 0.014 and 0.013, respectively). The uterine and myometrial 3D-PDA indices VI and VFI were statistically significantly higher in the group with deep invasion (P = 0.014 and 0.014; P = 0.013 and 0.022, respectively). No correlation was found between any of the measured indices and the presence of metastases. The subgroup analysis indicated that the uterine and myometrial VI was affected by distance, being statistically significantly higher in the group closer to the probe (P = 0.021 and 0.012, respectively). The multivariable analysis left the mean uterine artery RI as the only independent factor for the presence of deep invasion (OR 0.0003, 95%CI 0.00008–0.143, P = 0.010). Conclusions: The uterine artery RI correlates with the presence of deep invasion in endometrial carcinoma. 3D-PDA has potential in the preoperative assessment of endometrial carcinoma, but signal attenuation may bias the results.