Differential Diagnosis Of Endometrial Abnormality
Gray-scale transvaginal ultrasonography is not accurate in the detection of focal endometrial pathology. Currently second stage tests, such as saline contrast sonohysterography and office hysteroscopy are used for diagnosis of endometrial lesions. Both these second stage tests have limitations and side effects.
We proposed the "pedicle artery sign" at color Doppler imaging as an indicator of focal endometrial pathology, and assessed its use in a prospective observational study on 3099 consecutive patients.
Out of 2037 premenopausal and 1062 postmenopausal asymptomatic women (82%) or women with abnormal bleeding (18 %) no gold standard was available in 2230 because surgery or hysteroscopy was not clinically indicated. These patients were excluded from further analysis. There were only 28 patients that were test-positive and who did not have a gold standard. In the 869 patients where a gold standard was available, 182 had one or more endometrial polyps. The "pedicle artery sign" has an apparent sensitivity for endometrial polyps of 76.4 %, a specificity of 95.3 %, positive predictive value (PPV) of 81.3 %, and negative predictive value (NPV) of 93.8 %. When extending the test to the prediction of any focal intracavitary pathology the PPV is 94.2 %.
We conclude that the "pedicle artery" test has a very high PPV for focal intracavitary pathology and we expect that in the majority of patients with an endometrial polyp the "pedicle artery" test may replace more invasive established second stage tests, such as saline contrast sonohysterography and office hysteroscopy.