Ultrasonography criteria in differential diagnosis of endometrial polyps and chronic endometritis
The aim of this study was to determine the accuracy of ultrasonography in the diagnosis of endometrial polyps and the development of criteria for a differentiated approach to the hysteroscopy. Hysteroscopic study was conducted of 160 women aged 35-53 years who are at transvaginal ultrasound was diagnosed with «endometrial polyp». Women with chronic endometritis (9 cases, 5.6%) were the main group and 146 women with a confirmed diagnosis of endometrial polyp - a comparison group. The frequency of false-positive diagnoses of endometrial polyp was 8.8%. It is shown that the most informative signs of chronic endometritis is the presence of micro polyps (2 mm), especially multiple, hyperechoic inclusions in the endometrium; increase in endometrial thickness and mismatch of the thickness of the menstrual cycle phase. Upon detection of ultrasound endometrial polyps smaller than 2 mm in the findings suggest the need to exclude the presence of chronic endometritis, of anti-inflammatory therapy, and only subsequently the direction of patients to hysteroscopy.
2. Bulanov, M. N. (2010 – 2011). Ultrazvukovaya ginekologiya: kurs lekcij (T. 1-3 t.). Moskva: Vidar. [in Russian].
3. Demidov, V. N. & Gus, A. I. (2001). Patologiya polosti matki i endometriya. Moskva: NIKIET. [in Russian].
4. Ozerskaya, I. A. (2005). Ehografiya v ginekologii. Moskva: Medika. [in Russian].
5. Suhih, G. T. & Shurshalina, A. V. (2010). Hronicheskij endometrit: rukovodstvo. Moskva: GEOTAR-Media. [in Russian].
6. Shurshalina, A. V. (2007). Kliniko-morfologicheskie osobennosti hronicheskogo endometrita u zhenshin s narusheniem reproduktivnoj funkcii. (Dis. d-ra med. n.). Moskva. [in Russian].
7. Shurshalina, A. V. (2011). Hronicheskij endometrit: sovremennye vzglyady na problemu. Consilium Medicum (zhenskoe zdorove), 13(6), 36–39. [in Russian].
8. Cicinelli, E., Tinelli, R. & Lepera, A. (2010). Correspondence between hysteroscopic and hystologic findings in women with chronic endometritis. Acta Obstet. Gynecol. Scand., 89, 1061–1065.
9. Cicinelli E., De Ziegler, D. & Nicoletti, R. (2008). Chronic endometritis: correlation among hyseroscopic, hystologic and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. Fertility and Sterility, 89, 677–684.
10. Cicinelli, E., Resta, L. & Nicoletti, R. (2005). Detection of chronic endometritis at fluid hysteroscopy. J. of Minimally Invasive Gynecology, 12, 514–518.
11. Cicinelli, E., Resta, L. & Nicoletti, R. (2005b). Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum. Reprod., 20, 1386–1389.
12. Cicinelli, E., Matteo, M. & Tinelli, R. (2015). Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Human Reproduction, 30, 323–330.
13. Emanuel, M. H., Verdel, M. J. & Wamsteker, K. (2005). A prospective comparison of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding. clinical implications. Am. J. Obstet. Gynecol., 172, 547–552.
14. Epstein, E., Ramirez, A. & Skoog, L. (2001). Transvaginal sonography, saline contrast sonography and hysteroscopy for investigation of women with postmenopausal bleedind and endometrium > 5 mm. Ultrasound Obstetr. Gynecol., (18), 157–162.
15. Haggerty, C. L. Ness, R. B. & Amortegui, A. (2003). Endometritis does not predict reproductive morbidity after pelvic inflammatory disease. Am. J. Obstetr. Gynecol., 188, 141–148.
16. Kamel, H. S. Darwish, A. M. & Abdel-Rady, S. M. (2000). Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps. Acta Obstetr. Gynecol. Scand., 79, 60–64.
17. Melki, L. A. Henrique, Pinho Oliveira, M.A. & Oliveira H.C. (2008). Can Transvaginal Sonography Avoid the Diagnostic Complementary Hysteroscopy in the Detection of the Endometrial Polyp? Bras. J. Video-Sur., 1(2), 71–75.
18. Naji, A. Z. (2012). Enhance and Prove Diagnosis of Chronic Endometritis with CD-138 Immunostain. Medical J. of Babylon, 9(3), 34–38.
19. Padilla, L. A., Radosevich, D. M. & Milad, M. P. (2000). Accuracy of the Pelvic Examination in Detecting Adnexal Masses. Obs. & Gyn., 96(4), 593–598.
20. Towbin, N. A., Gviazda, I. M. & March, C. M. (1996). Office hysteroscopy versus transvaginal ultrasonography in the evaluation of patients with excessive uterine bleeding. Am. J. Obstet. Gynecol., 174, 1678–1682.