Can Transvaginal Sonography Avoid the Diagnostic Complementary Hysteroscopy in the Detection of the Endometrial Polyp

Objective: to evaluate if the diagnosis of endometrial polyp by transvaginal sonography has enough accuracy to avoid diagnostic hysteroscopy before polipectomy. Methods: we compared the detection of endometrial polyp by transvaginal sonography with the respective hysteroscopies in 451 pre and post-menopausal symptomatic and asymptomatic women, whose ages ranged from 22 to 91 years (mean age 49.1 years). Results: hysteroscopy detected 273 (60.5%) cases of endometrial polyps, 71 (15.8%) cases of normal uterine cavity, 51 (11.4%) cases of other diagnoses such as synechiae, chronic endometritis and focal calcifications, 23 (5.1%) cases of polypoid endometrium, 16 (3.5%) cases of endometrial thickness, 13 (2.8%) cases of submucous myoma, and 4 (0.9%) cases of adenocarcinoma. The positive predictive value of transvaginal sonography was 60.5% in the detection of the endometrial polyps. Conclusions: this study shows that the diagnosis of endometrial polyp by transvaginal sonography has just moderate positive predictive value in the detection of the endometrial polyps; therefore, it should not replace diagnostic hysteroscopy and biopsy under direct vision before polipectomy.