Comparison of Virtual Ultrasonographic Hysteroscopy (VUH) with standard hysteroscopy (H) in the work-up of infertile patients.

2020 
ABSTRACT STUDY OBJECTIVE To analyze the tolerability and diagnostic accuracy of virtual ultrasonographic hysteroscopy (VUH) in comparison to conventional diagnostic outpatient hysteroscopy (H) in the work-up of infertile patients. DESIGN A single-center, retrospective cohort study. SETTING Department of Obstetrics and Gynecologic Oncology and Minimally Invasive Pelvic Surgery Unit of Sacred Heart Hospital (Negrar, Italy). PATIENTS 120 consecutive women were included, who underwent hysterosalpingosonography and subsequent VUH and H for infertility evaluation. The inclusion criteria were infertility for at least one year, evaluation in the early or intermediate follicular phase of the menstrual cycle. INTERVENTIONS After placement of an intracervical catheter, a Ringer Lactate solution was injected into the uterine cavity and Fallopian tubes, and a 3D volume was obtained. The ultrasound volume acquired was successively elaborated off line, and VUH was performed. Subsequently, a variable amount of air was introduced in the uterine cavity and patency of the salpinges was evaluated. MEASUREMENTS AND MAIN RESULTS The findings at VUH were compared to those of conventional hysteroscopy (H) performed in the subsequent month. For the detection of endometrial pathology in the overall pooled, sensitivity and specificity of VUH in comparison to H were 100% (95%CI, 84.6-100%) and 100% (95%CI, 96.3–100%), respectively. For the detection of uterine cavity pathology and uterine malformations in the overall pooled, sensitivity of VUH were 80% (95%CI, 28.4-99.5%) and 100% (95%CI, 75.3–100%), with specificity of 100% (95%CI, 96.8-100%) and 100% (95%CI, 96.6-100%) respectively, when compared to H. PPV for endometrial pathology, uterine cavity alterations and uterine malformations were 100% (95%CI, 84.6–100%), 100% (95%CI, 39.8–100%) and 100% (95%CI, 75.3–100%), with a ROC area of 100%, 90% (95%CI, 70–100%), and 100%, respectively. There were no cases of severe vaso-vagal reactions or other complications. Most patients (67%, 81/120 women) described the exam as less painful than expected, 25% (30/120 patients) just as expected, and only 7% (9 patients) as more painful than expected. CONCLUSION VUH was well tolerated and showed a high accuracy (100%) in the study of uterine cavity when compared to H.
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