[Ultrasound diagnosis of focal intrauterine lesions]

Abstract

Objective: To compare the efficacy of the conventional grey-scale real time ultrasound, color Doppler ultrasound (color flow mapping) and hysteroscopy in the diagnosis of circumscript intrauterine lesions, such as endometrial polyps and submucosal myomas.

Methods: Preoperative transvaginal ultrasound data of 124 patients with focal intrauterine lesions, as confirmed by operative hysteroscopy, were elaborated. Using grey-scale ultrasound the detailed endometrial morphology, with color Doppler the vascularization pattern of the endometrium was examined. The ultrasound diagnosis, the hysteroscopic diagnosis and the histological diagnosis were matched and the sensitivity of conventional grey-scale ultrasound, color Doppler ultrasound and hysteroscopy were calculated. Age, menstrual and fertility status, medication and symptoms (abnormal bleeding) of patients were also evaluated.

Results: Of the 124 removed lesions the histological examination confirmed 114 endometrial polyps and 10 leiomyomas. Conventional grey-scale ultrasound was performed at 79 patients (TVS group), while 45 patient were examined by color Doppler ultrasound (TVCD group). In the TVS group the intrauterine lesion was detected in 59 cases, and the origin was also correctly diagnosed in 48 cases. In the TVCD group 42 lesions were detected, and the ultrasound diagnosis was consistent with the histological diagnosis in 41 cases. At hysteroscopy 118 endometrial polyps and 6 myoma were described. In this material the sensitivity of conventional transvaginal grey-scale ultrasound, the color Doppler ultrasound, and hysteroscopy in the detection of circumscript intrauterine lesions was 0.74, 0.93 and 1, respectively; in the diagnosis of the intrauterine lesion was 0.66, 0.91 and 0.97, respectively. Statistically significant differences were found between the ultrasound detection rates (p < 0.05) and between the diagnosis rates (p < 0.01) of the TVS and the TVCD group. Abnormal menopausal bleeding, recurrent bleeding, infertility, and tamoxifen therapy were present with high frequency in clinical data.

Conclusion: Visualization of the feeding vessels using color or power Doppler ultrasound imaging improves the detection rate and the ultrasound diagnosis of the circumscript intrauterine lesions, approaching the sensitivity of hysteroscopy. First line application is recommended for patients at risk, such as infertility, recurrent postmenopausal bleeding, or for patients receiving long term tamoxifen.