title: Diagnostic accuracy of 3D-transvaginal ultrasound in detecting uterine cavity abnormalities in infertile patients as compared with hysteroscopy.
abstract: OBJECTIVE
  To assess diagnostic accuracy of 3D transvaginal ultrasound (3D-TVS) compared with hysteroscopy in detecting uterine cavity abnormalities in infertile women.
  
  
  METHODS
  This prospective observational cross-sectional study was conducted during the July 2013 to December 2013 study period. Sixty-nine women with infertility were enrolled. In the mid to late follicular phase of each subject's menstrual cycle, 3D transvaginal ultrasound and hysteroscopy were performed on the same day in each patient. Hysteroscopy is widely considered to be the gold standard method for investigation of the uterine cavity. Uterine cavity characteristics and abnormalities were recorded. Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios were evaluated.
  
  
  RESULTS
  Hysteroscopy was successfully performed in all subjects. Hysteroscopy diagnosed pathological findings in 22 of 69 cases (31.8%). There were 18 endometrial polyps, 3 submucous myomas, and 1 septate uterus. Three-dimensional transvaginal ultrasound in comparison with hysteroscopy had 84.1% diagnostic accuracy, 68.2% sensitivity, 91.5% specificity, 79% positive predictive value, and 86% negative predictive value. The positive and negative likelihood ratios were 8.01 and 0.3, respectively. 3D-TVS successfully detected every case of submucous myoma and uterine anomaly. For detection of endometrial polyps, 3D-TVS had 61.1% sensitivity, 91.5% specificity, and 83.1% diagnostic accuracy.
  
  
  CONCLUSIONS
  3D-TVS demonstrated 84.1% diagnostic accuracy for detecting uterine cavity abnormalities in infertile women. A significant percentage of infertile patients had evidence of uterine cavity pathology. Hysteroscopy is, therefore, recommended for accurate detection and diagnosis of uterine cavity lesion.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Electronic address: chayaniss@hotmail.com.
authors.forename: Chayanis
authors.initials: C
authors.lastname: Apirakviriya
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Tassawan
authors.initials: T
authors.lastname: Rungruxsirivorn
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Vorapong
authors.initials: V
authors.lastname: Phupong
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Wirach
authors.initials: W
authors.lastname: Wisawasukmongchol
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005498:Follicular Phase; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000000981:diagnostic imaging*; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000473:pathology; D011127:Polyps / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013785:Thailand; D014463:Ultrasonography / Q000379:methods*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D014599:Uterus / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D014621:Vagina
keywords: 3D transvaginal ultrasound; Hysteroscopy; Infertility; Uterine cavity abnormality