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.


METHODS
Prospective pilot study.


METHODS
University hospital outpatient center.


METHODS
Forty-eight symptomatic (bleeding, infertility) premenopausal patients with submucous myomas.


METHODS
Preoperative grading of submucous myomas with a strict SHG methodology and standard transvaginal sonography compared with hysteroscopic grading of submucous myoma before hysteroscopic myomectomy.


METHODS
SHG and sonographic agreement with hysteroscopic findings.


RESULTS
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).


CONCLUSIONS
Strict and reproducible SHG diagnostic procedures proved to be as effective as hysteroscopy and well tolerated in preoperative grading of submucous myomas.
Department of Obstetrics and Gynecology, Clinical Sciences Institute L Sacco, University of Milan, Milan, Italy. fpgleone@libero.it
Francesco Paolo Giuseppe
FP
Leone
Chiara
C
Lanzani
Enrico
E
Ferrazzi
D000328:Adult; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007889:Leiomyoma / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging*