Sonographic versus clinical evaluation as predictors of residual trophoblastic tissue.
BACKGROUND
The study aims to compare the diagnostic accuracy of sonographic evaluation versus clinical estimation in women suspected to have retained trophoblastic fragments.


METHODS
The study group consisted of 68 consecutive patients admitted to our department due to suspected residual trophoblastic tissue. Each woman underwent ultrasound and physical examination by expert clinicians. The clinicians performing the physical examination were not informed of the sonographic findings, and vice versa.


RESULTS
Patients were divided into three subgroups: clinical suspicion only of residual trophoblastic tissue (n = 8), sonographic suspicion only (n = 44) and combined sonographic and clinical suspicion of residual trophoblastic tissue (n = 16). In the latter group, in 14 out of 16 women (87.5%) retained trophoblastic tissue was confirmed by histological examination, a significantly higher rate compared to ultrasonographic (45.5%, P < 0.002) or clinical suspicion only (62.5%, P = 0.07). The specificity and positive predictive value of the clinical examination were significantly higher compared to ultrasonographic evaluation (P < 0.05), while the sensitivity of the ultrasonographic evaluation was higher than the clinical estimation (P < 0.05). There was no statistically significant difference in the negative predictive value or in diagnostic accuracy between the two methods.


CONCLUSIONS
Based on our current experience, it seems that the combination of both clinical and ultrasonographic evaluation is recommended before uterine curettage is performed, thus lowering the rate of unnecessary invasive procedures.
Ben-Ami
Ido
I
Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin (affiliated with Sackler School of Medicine, Tel-Aviv University, Tel-Aviv), Israel. idorit@netvision.net.il
Schneider
David
D
Maymon
Ron
R
Vaknin
Zvika
Z
Herman
Arie
A
Halperin
Reuvit
R
D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000473:pathology; D000028:Abortion, Induced / Q000009:adverse effects; D000022:Abortion, Spontaneous / Q000150:complications; D000328:Adult; D005260:Female; D005334:Fever / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D010808:Physical Examination; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D011247:Pregnancy; D012680:Sensitivity and Specificity; D014327:Trophoblasts / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color