Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta-analysis

A.J. Vroom (Corresponding author), A. Timmermans, M.Y. Bongers, E.R. van den Heuvel, P.M.A.J. Geomini, N. van Hanegem

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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.

TaalEngels
Pagina's28-34
TijdschriftUltrasound in Obstetrics and Gynecology
Volume54
Nummer van het tijdschrift1
Vroegere onlinedatum12 jun 2019
DOI's
StatusGepubliceerd - 1 jul 2019

Vingerafdruk

Polyps
Meta-Analysis
Hemorrhage
Hysteroscopy
Contrast Sensitivity
ROC Curve
MEDLINE
Databases
Sensitivity and Specificity

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    @article{a5d6e31f663f4b5eb9828b168ec8fd0e,
    title = "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 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.",
    keywords = "endometrial neoplasm, polyp, postmenopause, sensitivity, specificity, ultrasonography",
    author = "A.J. Vroom and A. Timmermans and M.Y. Bongers and {van den Heuvel}, E.R. and P.M.A.J. Geomini and {van Hanegem}, N.",
    year = "2019",
    month = "7",
    day = "1",
    doi = "10.1002/uog.20229",
    language = "English",
    volume = "54",
    pages = "28--34",
    journal = "Ultrasound in Obstetrics and Gynecology",
    issn = "0960-7692",
    publisher = "Wiley",
    number = "1",

    }

    Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding : systematic review and meta-analysis. / Vroom, A.J. (Corresponding author); Timmermans, A.; Bongers, M.Y.; van den Heuvel, E.R.; Geomini, P.M.A.J.; van Hanegem, N.

    In: Ultrasound in Obstetrics and Gynecology, Vol. 54, Nr. 1, 01.07.2019, blz. 28-34.

    Onderzoeksoutput: Bijdrage aan tijdschriftArtikel recenserenAcademicpeer review

    TY - JOUR

    T1 - Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding

    T2 - Ultrasound in Obstetrics and Gynecology

    AU - Vroom,A.J.

    AU - Timmermans,A.

    AU - Bongers,M.Y.

    AU - van den Heuvel,E.R.

    AU - Geomini,P.M.A.J.

    AU - van Hanegem,N.

    PY - 2019/7/1

    Y1 - 2019/7/1

    N2 - 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.

    AB - 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.

    KW - endometrial neoplasm

    KW - polyp

    KW - postmenopause

    KW - sensitivity

    KW - specificity

    KW - ultrasonography

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    U2 - 10.1002/uog.20229

    DO - 10.1002/uog.20229

    M3 - Review article

    VL - 54

    SP - 28

    EP - 34

    JO - Ultrasound in Obstetrics and Gynecology

    JF - Ultrasound in Obstetrics and Gynecology

    SN - 0960-7692

    IS - 1

    ER -