Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta‐analysis
ABSTRACT Objective In women with postmenopausal bleeding, endometrial polyps are a frequent finding and the risk of a focal (pre)malignancy in a polyp is up to 6%. Because of this reported risk, the detection of polyps in these women, preferably by a minimally invasive method, is important. The aim...
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| Veröffentlicht in: | Ultrasound in obstetrics & gynecology 2019-07, Vol.54 (1), p.28-34 |
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| creator | Vroom, A. J. Timmermans, A. Bongers, M. Y. van den Heuvel, E. R. Geomini, P. M. A. J. van Hanegem, N. |
| description | ABSTRACT
Objective
In women with postmenopausal bleeding, endometrial polyps are a frequent finding and the risk of a focal (pre)malignancy in a polyp is up to 6%. Because of this reported risk, the detection of polyps in these women, preferably by a minimally invasive method, is important. The aim of this systematic review was to assess the accuracy of saline contrast sonohysterography (SCSH) for diagnosis of endometrial polyps in women with postmenopausal bleeding.
Methods
In August 2018, an electronic search was performed of MEDLINE, EMBASE and Web of Science databases to identify all diagnostic studies in which SCSH was used to detect endometrial polyps in postmenopausal women. Studies were included if SCSH was performed to detect endometrial polyps in women with postmenopausal bleeding and if detection of a polyp on hysteroscopy or diagnosis on histopathology was used as a reference standard. Two reviewers assessed methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS‐2) tool. Two separate analyses were performed for each reference standard. Pooled sensitivity and specificity were calculated using the hierarchical summary receiver–operating characteristics (HSROC) model and HSROC curves were plotted.
Results
After selection and quality assessment, five studies were included. Using ‘polyps diagnosed with histopathology’ as the reference standard, the pooled sensitivity of SCSH was 86.5% (95% CI, 63.6–100%) and the pooled specificity was 91.1% (95% CI, 63.2–100%). Using ‘polyps seen on hysteroscopy’ as the reference standard, the pooled sensitivity of SCSH was 85.1% (95% CI, 66.9–100%) and the pooled specificity was 84.5% (95% CI, 68.1–100%). Excluding the one study that included women in whom the SCSH examination was reported to be suboptimal, the pooled sensitivity increased to 90.7% (95% CI, 72.8–100%) using hysteroscopy as the reference standard. The sensitivity of hysteroscopy to detect polyps, as reported in two studies, was 81–98%.
Conclusions
Provided that the SCSH examination is of optimal quality, it can be considered as a method to stratify women with postmenopausal bleeding for further diagnostic workup and treatment with hysteroscopy. In women without suspicion of a polypoid lesion on SCSH, and with a benign endometrial sample, expectant management should be considered. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
RESUMEN
Precisión del diagnóstico de la sonohisterografía con contraste sali |
| doi_str_mv | 10.1002/uog.20229 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2179445793</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2259320583</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3889-4f0452a2b3f96375ab416dde3dae5a97b499f5da0ed7091ab9543f768dfac07d3</originalsourceid><addsrcrecordid>eNp1kcFu1DAQhi0EokvhwAsgS1zgkNaxE2fNDRUoSJV6oedoYk92XSV2sB1WufEIvERfrE-CwxYOSFw88sznz5Z_Ql6W7KxkjJ_PfnfGGefqEdmUlVQFa1j9mGyYkqxopOIn5FmMt4wxWQn5lJwIJpWoG7Uhdx8s7JyPyWoKWs8B9EJ9TyMM1iHV3qUAMdHond8vMWHwuwDTfqHWUYMJdbJuR9EZP2IKFgY6-WGZ4jo_5F5ebdrnZkx54yeYs5p2A6LJB9_RuEpHWO8P-N3igYIzNLvg_sdPcDAs0cbn5EkPQ8QXD_WU3Hz6-PXic3F1ffnl4v1VocV2q4qqZ1XNgXeiV1I0NXRVKY1BYQBrUE1XKdXXBhiahqkSOlVXom_k1vSgWWPEKXlz9E7Bf5sxpna0UeMwgEM_x5aXjaqq_HEio6__QW_9HPJ7M8VrJTirtyv19kjp4GMM2LdTsCOEpS1Zu2bX5uza39ll9tWDce5GNH_JP2Fl4PwIHOyAy_9N7c315VH5CzzGqWk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2259320583</pqid></control><display><type>article</type><title>Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta‐analysis</title><source>Wiley Free Content</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Vroom, A. J. ; Timmermans, A. ; Bongers, M. Y. ; van den Heuvel, E. R. ; Geomini, P. M. A. J. ; van Hanegem, N.</creator><creatorcontrib>Vroom, A. J. ; Timmermans, A. ; Bongers, M. Y. ; van den Heuvel, E. R. ; Geomini, P. M. A. J. ; van Hanegem, N.</creatorcontrib><description>ABSTRACT
Objective
In women with postmenopausal bleeding, endometrial polyps are a frequent finding and the risk of a focal (pre)malignancy in a polyp is up to 6%. Because of this reported risk, the detection of polyps in these women, preferably by a minimally invasive method, is important. The aim of this systematic review was to assess the accuracy of saline contrast sonohysterography (SCSH) for diagnosis of endometrial polyps in women with postmenopausal bleeding.
Methods
In August 2018, an electronic search was performed of MEDLINE, EMBASE and Web of Science databases to identify all diagnostic studies in which SCSH was used to detect endometrial polyps in postmenopausal women. Studies were included if SCSH was performed to detect endometrial polyps in women with postmenopausal bleeding and if detection of a polyp on hysteroscopy or diagnosis on histopathology was used as a reference standard. Two reviewers assessed methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS‐2) tool. Two separate analyses were performed for each reference standard. Pooled sensitivity and specificity were calculated using the hierarchical summary receiver–operating characteristics (HSROC) model and HSROC curves were plotted.
Results
After selection and quality assessment, five studies were included. Using ‘polyps diagnosed with histopathology’ as the reference standard, the pooled sensitivity of SCSH was 86.5% (95% CI, 63.6–100%) and the pooled specificity was 91.1% (95% CI, 63.2–100%). Using ‘polyps seen on hysteroscopy’ as the reference standard, the pooled sensitivity of SCSH was 85.1% (95% CI, 66.9–100%) and the pooled specificity was 84.5% (95% CI, 68.1–100%). Excluding the one study that included women in whom the SCSH examination was reported to be suboptimal, the pooled sensitivity increased to 90.7% (95% CI, 72.8–100%) using hysteroscopy as the reference standard. The sensitivity of hysteroscopy to detect polyps, as reported in two studies, was 81–98%.
Conclusions
Provided that the SCSH examination is of optimal quality, it can be considered as a method to stratify women with postmenopausal bleeding for further diagnostic workup and treatment with hysteroscopy. In women without suspicion of a polypoid lesion on SCSH, and with a benign endometrial sample, expectant management should be considered. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
RESUMEN
Precisión del diagnóstico de la sonohisterografía con contraste salino en la detección de pólipos endometriales en mujeres con hemorragia postmenopáusica: revisión sistemática y metaanálisis
Objetivo
En las mujeres con hemorragia postmenopáusica, los pólipos endometriales son frecuentes y el riesgo de una (pre)malignidad focal en un pólipo es de hasta el 6%. Debido a este riesgo reportado, es importante la detección de pólipos en estas mujeres, preferiblemente por un método mínimamente invasivo. El objetivo de esta revisión sistemática fue evaluar la precisión de la sonohisterografía con contraste salino (SCSH, por sus siglas en inglés) para el diagnóstico de pólipos endometriales en mujeres con hemorragia postmenopáusica.
Métodos
En agosto de 2018 se realizó una búsqueda electrónica en las bases de datos MEDLINE, EMBASE y Web of Science para identificar todos los estudios diagnósticos en los que se utilizó la SCSH para detectar pólipos endometriales en mujeres postmenopáusicas. Los estudios se incluyeron cuando la SCSH se realizó para detectar pólipos endometriales en mujeres con hemorragia postmenopáusica o cuando la detección de un pólipo en la histeroscopia o el diagnóstico sobre la histopatología se utilizó como estándar de referencia. Dos revisores evaluaron la calidad metodológica mediante la evaluación de calidad de la herramienta de estudios de precisión diagnóstica (QUADAS‐2). Se realizaron dos análisis separados para cada estándar de referencia. La sensibilidad y especificidad combinadas se calcularon utilizando el modelo jerárquico de resumen de las características operativas del receptor (HSROC, por sus siglas en inglés) y se trazaron las curvas HSROC.
Resultados
Después de la selección y la evaluación de calidad, se incluyeron cinco estudios. Utilizando los ‘pólipos diagnosticados con histopatología’ como estándar de referencia, la sensibilidad combinada de la SCSH fue del 86,5% (IC 95%, 63,6–100%) y la especificidad combinada fue del 91,1% (IC 95%, 63,2–100%). Utilizando como estándar de referencia los ‘pólipos observados en la histeroscopia’, la sensibilidad combinada de la SCSH fue del 85,1% (IC 95%: 66,9–100%) y la especificidad combinada fue del 84,5% (IC 95%: 68,1–100%). Excluyendo el único estudio que incluyó mujeres en las que se reportó que el examen por SCSH no fue adecuado, la sensibilidad combinada aumentó al 90,7% (IC 95%: 72,8–100%), usando la histeroscopia como estándar de referencia. La sensibilidad de la histeroscopia para detectar pólipos, tal y como se informó en dos estudios, fue del 81–98%.
Conclusiones
Siempre que el examen por SCSH sea de calidad óptima, puede considerarse como un método para estratificar a las mujeres con hemorragia postmenopáusica para su posterior diagnóstico y tratamiento con histeroscopia. En mujeres sin sospecha de una lesión polipoide mediante SCSH y con una muestra endometrial benigna, se debe considerar el tratamiento expectante. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
摘要
盐水增强超声造影在检测绝经后出血妇女子宫内膜息肉时诊断的准确性:系统回顾及Meta分析
目的
在绝经后出血的妇女中，子宫内膜息肉为常见原因，而息肉发生局灶性(前期)恶化的风险高达6%。因为报告的风险，所以在这些妇女中检测息肉时，最好采用微创方法，这非常重要。本系统回顾的目的是评估盐水增强超声造影(SCSH)诊断绝经后出血妇女子宫内膜息肉的准确性。
方法
2018年8月，对 MEDLINE、EMBASE 和 WebofScience 数据库进行电子检索，以确定所有诊断性研究，其中SCSH用于检测绝经后妇女子宫内膜息肉。研究包括:是否对绝经后出血的妇女进行SCSH检测子宫内膜息肉，是否将宫腔镜检查或组织病理学诊断中的息肉检测作为参考标准。两位评审员使用诊断准确性研究(QUADAS‐2)的质量评估工具对方法学质量进行了评估。每个参考标准分别进行了两次分析。采用分层汇总接受者‐操作特征(HSROC)模型计算综合敏感性和特异性，绘制HSROC曲线。
结果
经过筛选和质量评估，共纳入5项研究。以组织病理学诊断的息肉为参考标准，SCSH的综合敏感性为86.5%(95% CI，63.6%‐100%)，综合特异性为91.1%(95% CI，63.2%‐100%)。以宫腔镜所见息肉为参考标准，SCSH的综合敏感性为85.1%(95%CI，66.9%~100%)，综合特异性为84.5%(95%CI，68.1%~100%)。一项报告纳入女性SCSH检查结果不理想的研究除外，以宫腔镜检查为参照，综合敏感度提高到90.7%(95% CI，72.8%‐100%)。根据两项研究报告，宫腔镜检查息肉的敏感性为81%‐98%。
结论
只要SCSH检查质量最佳，可将其作为对绝经后出血妇女进行分层的一种方法，以进一步进行诊断性检查和宫腔镜治疗。对于不怀疑SCSH上有息肉样病变且子宫内膜样本为良性的女性，应考虑预期治疗。
This article has been selected for Journal Club. Click here to view slides and discussion points.
This article's has been translated into Spanish and Chinese. Follow the links from the to view the translations.</description><identifier>ISSN: 0960-7692</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.20229</identifier><identifier>PMID: 30693579</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Accuracy ; Bleeding ; Contrast Media - administration & dosage ; Diagnosis ; Diagnostic software ; Diagnostic systems ; Endometrial cancer ; endometrial neoplasm ; Endometrium ; Endometrium - pathology ; Evidence-based medicine ; Female ; Histopathology ; Hormone replacement therapy ; Humans ; Hysteroscopy - methods ; Hysteroscopy - standards ; Malignancy ; Medical diagnosis ; Meta-analysis ; polyp ; Polyps ; Polyps - diagnostic imaging ; Polyps - pathology ; Post-menopause ; postmenopause ; Postmenopause - physiology ; Quality assessment ; Quality control ; Sensitivity ; Sensitivity analysis ; Sensitivity and Specificity ; Sodium Chloride - administration & dosage ; specificity ; Systematic review ; ultrasonography ; Ultrasonography - methods ; Uterine Hemorrhage - etiology ; Uterine Hemorrhage - physiopathology ; Uterus - diagnostic imaging ; Uterus - pathology ; Womens health</subject><ispartof>Ultrasound in obstetrics & gynecology, 2019-07, Vol.54 (1), p.28-34</ispartof><rights>Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3889-4f0452a2b3f96375ab416dde3dae5a97b499f5da0ed7091ab9543f768dfac07d3</citedby><cites>FETCH-LOGICAL-c3889-4f0452a2b3f96375ab416dde3dae5a97b499f5da0ed7091ab9543f768dfac07d3</cites><orcidid>0000-0002-4782-1805</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fuog.20229$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fuog.20229$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30693579$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vroom, A. J.</creatorcontrib><creatorcontrib>Timmermans, A.</creatorcontrib><creatorcontrib>Bongers, M. Y.</creatorcontrib><creatorcontrib>van den Heuvel, E. R.</creatorcontrib><creatorcontrib>Geomini, P. M. A. J.</creatorcontrib><creatorcontrib>van Hanegem, N.</creatorcontrib><title>Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta‐analysis</title><title>Ultrasound in obstetrics & gynecology</title><addtitle>Ultrasound Obstet Gynecol</addtitle><description>ABSTRACT
Objective
In women with postmenopausal bleeding, endometrial polyps are a frequent finding and the risk of a focal (pre)malignancy in a polyp is up to 6%. Because of this reported risk, the detection of polyps in these women, preferably by a minimally invasive method, is important. The aim of this systematic review was to assess the accuracy of saline contrast sonohysterography (SCSH) for diagnosis of endometrial polyps in women with postmenopausal bleeding.
Methods
In August 2018, an electronic search was performed of MEDLINE, EMBASE and Web of Science databases to identify all diagnostic studies in which SCSH was used to detect endometrial polyps in postmenopausal women. Studies were included if SCSH was performed to detect endometrial polyps in women with postmenopausal bleeding and if detection of a polyp on hysteroscopy or diagnosis on histopathology was used as a reference standard. Two reviewers assessed methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS‐2) tool. Two separate analyses were performed for each reference standard. Pooled sensitivity and specificity were calculated using the hierarchical summary receiver–operating characteristics (HSROC) model and HSROC curves were plotted.
Results
After selection and quality assessment, five studies were included. Using ‘polyps diagnosed with histopathology’ as the reference standard, the pooled sensitivity of SCSH was 86.5% (95% CI, 63.6–100%) and the pooled specificity was 91.1% (95% CI, 63.2–100%). Using ‘polyps seen on hysteroscopy’ as the reference standard, the pooled sensitivity of SCSH was 85.1% (95% CI, 66.9–100%) and the pooled specificity was 84.5% (95% CI, 68.1–100%). Excluding the one study that included women in whom the SCSH examination was reported to be suboptimal, the pooled sensitivity increased to 90.7% (95% CI, 72.8–100%) using hysteroscopy as the reference standard. The sensitivity of hysteroscopy to detect polyps, as reported in two studies, was 81–98%.
Conclusions
Provided that the SCSH examination is of optimal quality, it can be considered as a method to stratify women with postmenopausal bleeding for further diagnostic workup and treatment with hysteroscopy. In women without suspicion of a polypoid lesion on SCSH, and with a benign endometrial sample, expectant management should be considered. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
RESUMEN
Precisión del diagnóstico de la sonohisterografía con contraste salino en la detección de pólipos endometriales en mujeres con hemorragia postmenopáusica: revisión sistemática y metaanálisis
Objetivo
En las mujeres con hemorragia postmenopáusica, los pólipos endometriales son frecuentes y el riesgo de una (pre)malignidad focal en un pólipo es de hasta el 6%. Debido a este riesgo reportado, es importante la detección de pólipos en estas mujeres, preferiblemente por un método mínimamente invasivo. El objetivo de esta revisión sistemática fue evaluar la precisión de la sonohisterografía con contraste salino (SCSH, por sus siglas en inglés) para el diagnóstico de pólipos endometriales en mujeres con hemorragia postmenopáusica.
Métodos
En agosto de 2018 se realizó una búsqueda electrónica en las bases de datos MEDLINE, EMBASE y Web of Science para identificar todos los estudios diagnósticos en los que se utilizó la SCSH para detectar pólipos endometriales en mujeres postmenopáusicas. Los estudios se incluyeron cuando la SCSH se realizó para detectar pólipos endometriales en mujeres con hemorragia postmenopáusica o cuando la detección de un pólipo en la histeroscopia o el diagnóstico sobre la histopatología se utilizó como estándar de referencia. Dos revisores evaluaron la calidad metodológica mediante la evaluación de calidad de la herramienta de estudios de precisión diagnóstica (QUADAS‐2). Se realizaron dos análisis separados para cada estándar de referencia. La sensibilidad y especificidad combinadas se calcularon utilizando el modelo jerárquico de resumen de las características operativas del receptor (HSROC, por sus siglas en inglés) y se trazaron las curvas HSROC.
Resultados
Después de la selección y la evaluación de calidad, se incluyeron cinco estudios. Utilizando los ‘pólipos diagnosticados con histopatología’ como estándar de referencia, la sensibilidad combinada de la SCSH fue del 86,5% (IC 95%, 63,6–100%) y la especificidad combinada fue del 91,1% (IC 95%, 63,2–100%). Utilizando como estándar de referencia los ‘pólipos observados en la histeroscopia’, la sensibilidad combinada de la SCSH fue del 85,1% (IC 95%: 66,9–100%) y la especificidad combinada fue del 84,5% (IC 95%: 68,1–100%). Excluyendo el único estudio que incluyó mujeres en las que se reportó que el examen por SCSH no fue adecuado, la sensibilidad combinada aumentó al 90,7% (IC 95%: 72,8–100%), usando la histeroscopia como estándar de referencia. La sensibilidad de la histeroscopia para detectar pólipos, tal y como se informó en dos estudios, fue del 81–98%.
Conclusiones
Siempre que el examen por SCSH sea de calidad óptima, puede considerarse como un método para estratificar a las mujeres con hemorragia postmenopáusica para su posterior diagnóstico y tratamiento con histeroscopia. En mujeres sin sospecha de una lesión polipoide mediante SCSH y con una muestra endometrial benigna, se debe considerar el tratamiento expectante. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
摘要
盐水增强超声造影在检测绝经后出血妇女子宫内膜息肉时诊断的准确性:系统回顾及Meta分析
目的
在绝经后出血的妇女中，子宫内膜息肉为常见原因，而息肉发生局灶性(前期)恶化的风险高达6%。因为报告的风险，所以在这些妇女中检测息肉时，最好采用微创方法，这非常重要。本系统回顾的目的是评估盐水增强超声造影(SCSH)诊断绝经后出血妇女子宫内膜息肉的准确性。
方法
2018年8月，对 MEDLINE、EMBASE 和 WebofScience 数据库进行电子检索，以确定所有诊断性研究，其中SCSH用于检测绝经后妇女子宫内膜息肉。研究包括:是否对绝经后出血的妇女进行SCSH检测子宫内膜息肉，是否将宫腔镜检查或组织病理学诊断中的息肉检测作为参考标准。两位评审员使用诊断准确性研究(QUADAS‐2)的质量评估工具对方法学质量进行了评估。每个参考标准分别进行了两次分析。采用分层汇总接受者‐操作特征(HSROC)模型计算综合敏感性和特异性，绘制HSROC曲线。
结果
经过筛选和质量评估，共纳入5项研究。以组织病理学诊断的息肉为参考标准，SCSH的综合敏感性为86.5%(95% CI，63.6%‐100%)，综合特异性为91.1%(95% CI，63.2%‐100%)。以宫腔镜所见息肉为参考标准，SCSH的综合敏感性为85.1%(95%CI，66.9%~100%)，综合特异性为84.5%(95%CI，68.1%~100%)。一项报告纳入女性SCSH检查结果不理想的研究除外，以宫腔镜检查为参照，综合敏感度提高到90.7%(95% CI，72.8%‐100%)。根据两项研究报告，宫腔镜检查息肉的敏感性为81%‐98%。
结论
只要SCSH检查质量最佳，可将其作为对绝经后出血妇女进行分层的一种方法，以进一步进行诊断性检查和宫腔镜治疗。对于不怀疑SCSH上有息肉样病变且子宫内膜样本为良性的女性，应考虑预期治疗。
This article has been selected for Journal Club. Click here to view slides and discussion points.
This article's has been translated into Spanish and Chinese. Follow the links from the to view the translations.</description><subject>Accuracy</subject><subject>Bleeding</subject><subject>Contrast Media - administration & dosage</subject><subject>Diagnosis</subject><subject>Diagnostic software</subject><subject>Diagnostic systems</subject><subject>Endometrial cancer</subject><subject>endometrial neoplasm</subject><subject>Endometrium</subject><subject>Endometrium - pathology</subject><subject>Evidence-based medicine</subject><subject>Female</subject><subject>Histopathology</subject><subject>Hormone replacement therapy</subject><subject>Humans</subject><subject>Hysteroscopy - methods</subject><subject>Hysteroscopy - standards</subject><subject>Malignancy</subject><subject>Medical diagnosis</subject><subject>Meta-analysis</subject><subject>polyp</subject><subject>Polyps</subject><subject>Polyps - diagnostic imaging</subject><subject>Polyps - pathology</subject><subject>Post-menopause</subject><subject>postmenopause</subject><subject>Postmenopause - physiology</subject><subject>Quality assessment</subject><subject>Quality control</subject><subject>Sensitivity</subject><subject>Sensitivity analysis</subject><subject>Sensitivity and Specificity</subject><subject>Sodium Chloride - administration & dosage</subject><subject>specificity</subject><subject>Systematic review</subject><subject>ultrasonography</subject><subject>Ultrasonography - methods</subject><subject>Uterine Hemorrhage - etiology</subject><subject>Uterine Hemorrhage - physiopathology</subject><subject>Uterus - diagnostic imaging</subject><subject>Uterus - pathology</subject><subject>Womens health</subject><issn>0960-7692</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFu1DAQhi0EokvhwAsgS1zgkNaxE2fNDRUoSJV6oedoYk92XSV2sB1WufEIvERfrE-CwxYOSFw88sznz5Z_Ql6W7KxkjJ_PfnfGGefqEdmUlVQFa1j9mGyYkqxopOIn5FmMt4wxWQn5lJwIJpWoG7Uhdx8s7JyPyWoKWs8B9EJ9TyMM1iHV3qUAMdHond8vMWHwuwDTfqHWUYMJdbJuR9EZP2IKFgY6-WGZ4jo_5F5ebdrnZkx54yeYs5p2A6LJB9_RuEpHWO8P-N3igYIzNLvg_sdPcDAs0cbn5EkPQ8QXD_WU3Hz6-PXic3F1ffnl4v1VocV2q4qqZ1XNgXeiV1I0NXRVKY1BYQBrUE1XKdXXBhiahqkSOlVXom_k1vSgWWPEKXlz9E7Bf5sxpna0UeMwgEM_x5aXjaqq_HEio6__QW_9HPJ7M8VrJTirtyv19kjp4GMM2LdTsCOEpS1Zu2bX5uza39ll9tWDce5GNH_JP2Fl4PwIHOyAy_9N7c315VH5CzzGqWk</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>Vroom, A. J.</creator><creator>Timmermans, A.</creator><creator>Bongers, M. Y.</creator><creator>van den Heuvel, E. R.</creator><creator>Geomini, P. M. A. J.</creator><creator>van Hanegem, N.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4782-1805</orcidid></search><sort><creationdate>201907</creationdate><title>Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta‐analysis</title><author>Vroom, A. J. ; Timmermans, A. ; Bongers, M. Y. ; van den Heuvel, E. R. ; Geomini, P. M. A. J. ; van Hanegem, N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3889-4f0452a2b3f96375ab416dde3dae5a97b499f5da0ed7091ab9543f768dfac07d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Accuracy</topic><topic>Bleeding</topic><topic>Contrast Media - administration & dosage</topic><topic>Diagnosis</topic><topic>Diagnostic software</topic><topic>Diagnostic systems</topic><topic>Endometrial cancer</topic><topic>endometrial neoplasm</topic><topic>Endometrium</topic><topic>Endometrium - pathology</topic><topic>Evidence-based medicine</topic><topic>Female</topic><topic>Histopathology</topic><topic>Hormone replacement therapy</topic><topic>Humans</topic><topic>Hysteroscopy - methods</topic><topic>Hysteroscopy - standards</topic><topic>Malignancy</topic><topic>Medical diagnosis</topic><topic>Meta-analysis</topic><topic>polyp</topic><topic>Polyps</topic><topic>Polyps - diagnostic imaging</topic><topic>Polyps - pathology</topic><topic>Post-menopause</topic><topic>postmenopause</topic><topic>Postmenopause - physiology</topic><topic>Quality assessment</topic><topic>Quality control</topic><topic>Sensitivity</topic><topic>Sensitivity analysis</topic><topic>Sensitivity and Specificity</topic><topic>Sodium Chloride - administration & dosage</topic><topic>specificity</topic><topic>Systematic review</topic><topic>ultrasonography</topic><topic>Ultrasonography - methods</topic><topic>Uterine Hemorrhage - etiology</topic><topic>Uterine Hemorrhage - physiopathology</topic><topic>Uterus - diagnostic imaging</topic><topic>Uterus - pathology</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vroom, A. J.</creatorcontrib><creatorcontrib>Timmermans, A.</creatorcontrib><creatorcontrib>Bongers, M. Y.</creatorcontrib><creatorcontrib>van den Heuvel, E. R.</creatorcontrib><creatorcontrib>Geomini, P. M. A. J.</creatorcontrib><creatorcontrib>van Hanegem, N.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Ultrasound in obstetrics & gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vroom, A. J.</au><au>Timmermans, A.</au><au>Bongers, M. Y.</au><au>van den Heuvel, E. R.</au><au>Geomini, P. M. A. J.</au><au>van Hanegem, N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta‐analysis</atitle><jtitle>Ultrasound in obstetrics & gynecology</jtitle><addtitle>Ultrasound Obstet Gynecol</addtitle><date>2019-07</date><risdate>2019</risdate><volume>54</volume><issue>1</issue><spage>28</spage><epage>34</epage><pages>28-34</pages><issn>0960-7692</issn><eissn>1469-0705</eissn><abstract>ABSTRACT
Objective
In women with postmenopausal bleeding, endometrial polyps are a frequent finding and the risk of a focal (pre)malignancy in a polyp is up to 6%. Because of this reported risk, the detection of polyps in these women, preferably by a minimally invasive method, is important. The aim of this systematic review was to assess the accuracy of saline contrast sonohysterography (SCSH) for diagnosis of endometrial polyps in women with postmenopausal bleeding.
Methods
In August 2018, an electronic search was performed of MEDLINE, EMBASE and Web of Science databases to identify all diagnostic studies in which SCSH was used to detect endometrial polyps in postmenopausal women. Studies were included if SCSH was performed to detect endometrial polyps in women with postmenopausal bleeding and if detection of a polyp on hysteroscopy or diagnosis on histopathology was used as a reference standard. Two reviewers assessed methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS‐2) tool. Two separate analyses were performed for each reference standard. Pooled sensitivity and specificity were calculated using the hierarchical summary receiver–operating characteristics (HSROC) model and HSROC curves were plotted.
Results
After selection and quality assessment, five studies were included. Using ‘polyps diagnosed with histopathology’ as the reference standard, the pooled sensitivity of SCSH was 86.5% (95% CI, 63.6–100%) and the pooled specificity was 91.1% (95% CI, 63.2–100%). Using ‘polyps seen on hysteroscopy’ as the reference standard, the pooled sensitivity of SCSH was 85.1% (95% CI, 66.9–100%) and the pooled specificity was 84.5% (95% CI, 68.1–100%). Excluding the one study that included women in whom the SCSH examination was reported to be suboptimal, the pooled sensitivity increased to 90.7% (95% CI, 72.8–100%) using hysteroscopy as the reference standard. The sensitivity of hysteroscopy to detect polyps, as reported in two studies, was 81–98%.
Conclusions
Provided that the SCSH examination is of optimal quality, it can be considered as a method to stratify women with postmenopausal bleeding for further diagnostic workup and treatment with hysteroscopy. In women without suspicion of a polypoid lesion on SCSH, and with a benign endometrial sample, expectant management should be considered. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
RESUMEN
Precisión del diagnóstico de la sonohisterografía con contraste salino en la detección de pólipos endometriales en mujeres con hemorragia postmenopáusica: revisión sistemática y metaanálisis
Objetivo
En las mujeres con hemorragia postmenopáusica, los pólipos endometriales son frecuentes y el riesgo de una (pre)malignidad focal en un pólipo es de hasta el 6%. Debido a este riesgo reportado, es importante la detección de pólipos en estas mujeres, preferiblemente por un método mínimamente invasivo. El objetivo de esta revisión sistemática fue evaluar la precisión de la sonohisterografía con contraste salino (SCSH, por sus siglas en inglés) para el diagnóstico de pólipos endometriales en mujeres con hemorragia postmenopáusica.
Métodos
En agosto de 2018 se realizó una búsqueda electrónica en las bases de datos MEDLINE, EMBASE y Web of Science para identificar todos los estudios diagnósticos en los que se utilizó la SCSH para detectar pólipos endometriales en mujeres postmenopáusicas. Los estudios se incluyeron cuando la SCSH se realizó para detectar pólipos endometriales en mujeres con hemorragia postmenopáusica o cuando la detección de un pólipo en la histeroscopia o el diagnóstico sobre la histopatología se utilizó como estándar de referencia. Dos revisores evaluaron la calidad metodológica mediante la evaluación de calidad de la herramienta de estudios de precisión diagnóstica (QUADAS‐2). Se realizaron dos análisis separados para cada estándar de referencia. La sensibilidad y especificidad combinadas se calcularon utilizando el modelo jerárquico de resumen de las características operativas del receptor (HSROC, por sus siglas en inglés) y se trazaron las curvas HSROC.
Resultados
Después de la selección y la evaluación de calidad, se incluyeron cinco estudios. Utilizando los ‘pólipos diagnosticados con histopatología’ como estándar de referencia, la sensibilidad combinada de la SCSH fue del 86,5% (IC 95%, 63,6–100%) y la especificidad combinada fue del 91,1% (IC 95%, 63,2–100%). Utilizando como estándar de referencia los ‘pólipos observados en la histeroscopia’, la sensibilidad combinada de la SCSH fue del 85,1% (IC 95%: 66,9–100%) y la especificidad combinada fue del 84,5% (IC 95%: 68,1–100%). Excluyendo el único estudio que incluyó mujeres en las que se reportó que el examen por SCSH no fue adecuado, la sensibilidad combinada aumentó al 90,7% (IC 95%: 72,8–100%), usando la histeroscopia como estándar de referencia. La sensibilidad de la histeroscopia para detectar pólipos, tal y como se informó en dos estudios, fue del 81–98%.
Conclusiones
Siempre que el examen por SCSH sea de calidad óptima, puede considerarse como un método para estratificar a las mujeres con hemorragia postmenopáusica para su posterior diagnóstico y tratamiento con histeroscopia. En mujeres sin sospecha de una lesión polipoide mediante SCSH y con una muestra endometrial benigna, se debe considerar el tratamiento expectante. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
摘要
盐水增强超声造影在检测绝经后出血妇女子宫内膜息肉时诊断的准确性:系统回顾及Meta分析
目的
在绝经后出血的妇女中，子宫内膜息肉为常见原因，而息肉发生局灶性(前期)恶化的风险高达6%。因为报告的风险，所以在这些妇女中检测息肉时，最好采用微创方法，这非常重要。本系统回顾的目的是评估盐水增强超声造影(SCSH)诊断绝经后出血妇女子宫内膜息肉的准确性。
方法
2018年8月，对 MEDLINE、EMBASE 和 WebofScience 数据库进行电子检索，以确定所有诊断性研究，其中SCSH用于检测绝经后妇女子宫内膜息肉。研究包括:是否对绝经后出血的妇女进行SCSH检测子宫内膜息肉，是否将宫腔镜检查或组织病理学诊断中的息肉检测作为参考标准。两位评审员使用诊断准确性研究(QUADAS‐2)的质量评估工具对方法学质量进行了评估。每个参考标准分别进行了两次分析。采用分层汇总接受者‐操作特征(HSROC)模型计算综合敏感性和特异性，绘制HSROC曲线。
结果
经过筛选和质量评估，共纳入5项研究。以组织病理学诊断的息肉为参考标准，SCSH的综合敏感性为86.5%(95% CI，63.6%‐100%)，综合特异性为91.1%(95% CI，63.2%‐100%)。以宫腔镜所见息肉为参考标准，SCSH的综合敏感性为85.1%(95%CI，66.9%~100%)，综合特异性为84.5%(95%CI，68.1%~100%)。一项报告纳入女性SCSH检查结果不理想的研究除外，以宫腔镜检查为参照，综合敏感度提高到90.7%(95% CI，72.8%‐100%)。根据两项研究报告，宫腔镜检查息肉的敏感性为81%‐98%。
结论
只要SCSH检查质量最佳，可将其作为对绝经后出血妇女进行分层的一种方法，以进一步进行诊断性检查和宫腔镜治疗。对于不怀疑SCSH上有息肉样病变且子宫内膜样本为良性的女性，应考虑预期治疗。
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This article's has been translated into Spanish and Chinese. Follow the links from the to view the translations.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>30693579</pmid><doi>10.1002/uog.20229</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-4782-1805</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Ultrasound in obstetrics & gynecology, 2019-07, Vol.54 (1), p.28-34 |
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| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Accuracy Bleeding Contrast Media - administration & dosage Diagnosis Diagnostic software Diagnostic systems Endometrial cancer endometrial neoplasm Endometrium Endometrium - pathology Evidence-based medicine Female Histopathology Hormone replacement therapy Humans Hysteroscopy - methods Hysteroscopy - standards Malignancy Medical diagnosis Meta-analysis polyp Polyps Polyps - diagnostic imaging Polyps - pathology Post-menopause postmenopause Postmenopause - physiology Quality assessment Quality control Sensitivity Sensitivity analysis Sensitivity and Specificity Sodium Chloride - administration & dosage specificity Systematic review ultrasonography Ultrasonography - methods Uterine Hemorrhage - etiology Uterine Hemorrhage - physiopathology Uterus - diagnostic imaging Uterus - pathology Womens health |
| title | Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta‐analysis |
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