Diagnostic accuracy of three dimensional sonohysterography compared with office hysteroscopy and its interrater intrarater agreement in uterine cavity assessment after hysteroscopic metroplasty

Capsule:
Three-dimensional sonohysterography—a minimally invasive and relatively inexpensive method with substantial interrater/intrarater agreement coefficients for the postoperative evaluation of the uterine cavity—is as diagnostically accurate as hysteroscopy.

Authors:
Artur Ludwin, M.D., Ph.D., Inga Ludwin, M.D., Ph.D., Marek Kudla, M.D., Ph.D., Kazimierz Pitynski, M.D., Ph.D., Tomasz Banas, M.D., Ph.D., M.P.H., Robert Jach, M.D., Ph.D., Anna Knafel, M.D., Ph.D.

Volume 101, Issue 5, Pages 1392–1399.e4

Abstract:

Objective:
To compare the diagnostic accuracy of three-dimensional sonohysterography (3D-SIS) and office hysteroscopy in uterine cavity assessment after hysteroscopic metroplasty (HM) and determine the interrater/intrarater agreement for 3D-SIS.

Design:
Prospective observational study.

Setting:
University hospital, private hospital, and clinic.

Patient(s):
One hundred forty-one women undergoing HM for septate uterus with a history of miscarriage and/or infertility.

Intervention(s):
3D-SIS and office hysteroscopy at 6–8 weeks after HM.

Main Outcome Measure(s):
Shape of the uterine cavity, length of the fundal notch (≥1 or <1 cm), and the presence of intrauterine adhesions were assessed, and the interrater/intrarater agreement of 3D-SIS was evaluated in 30 randomly selected patients. Result(s):
Uterine abnormalities were detected with the use of hysteroscopy in 18 (12.8%) of 141 women. 3D-SIS was highly accurate (97.2%), sensitive (97%), and specific (100%), with a positive predictive value of 100% and a negative predictive value of 85%. The diagnostic values of hysteroscopy and 3D-SIS were not significantly different (McNemar test). 3D-SIS showed substantial interrater/intrarater agreement regarding overall uterine cavity evaluation (κ = 0.79 and 0.78, respectively).

Conclusion(s):
3D-SIS demonstrated substantial interrater/intrarater agreement for the postoperative evaluation of the uterine cavity, being as diagnostically accurate as hysteroscopy. The use of second-look hysteroscopy may be limited to cases that require reoperation.

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