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Sonographic based triage – transvaginal sonography (TVS) and sonohysterography (SHG) – for benign uterine lesions and surgical management
Author(s) -
Leone F. P. G.,
Tonta A.,
Lanzani C.,
Di Grandi M.,
Mastromatteo C.
Publication year - 2001
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2001.0180s1040.x
Subject(s) - medicine , hysterectomy , hysteroscopy , endometrial hyperplasia , triage , radiology , leiomyoma , curettage , surgery , endometrium , obstetrics , emergency medicine
Purpose: To assess the reduction of clinical indications to hysterectomy as a consequence of sonographic based triage – transvaginal sonography (TVS) and sonohysterography (SHG) – in the surgical management of benign uterine lesions. Methods: All women undergoing surgery for symptomatic (methrorragia) benign uterine lesions were included. Women with prolapse, cervical lesions and malignant lesions were excluded. Data from 180 and 154 patients treated during 1998–99 (group A) and the year 2000 (group B), respectively, were analyzed. Diagnostic triage: All patients had complete history collected and pelvic examination performed. Group A. Patients were evaluated by TVS – not mandatory – VABRA curettage and/or D&C and/or diagnostic histeroscopy with biopsy. Group B. All patients were evaluated by TVS and in case of endometrial thickness >4 mm, a SHG was performed to distinguish focal lesions (polyps, myomas, focal hyperplasia) and diffuse lesions (hyperplasia). Theraputic protocol (in group A) was decided in each single case by the medical‐equipe; in group B: patients with focal endocavitary lesions underwent operative hysteroscopy. Patients with diffuse lesions underwent hysteroscopy and endometrial guided biopsy. Indications to abdominal miomectomy were: submucous myomas (G0–G1) > 5 cm, G2 or subserous myomas in women asking to preserve the uterus. Indications to hysterectomy (vaginal/abdominal) were large miometrial lesions non‐responding to medical therapy. Results: Median age of group A and B patients was not significantly different (46 years, interquartile range 40–56). The frequency of abdominal/vaginal hysterectomy was significantly lower in group B (28%) than in group A (54%) ( P < 0.01). Laparotomic myomectomy were not significantly different in the two series (24% vs. 22%). The frequency of operative hysteroscopy was significantly higher group B 63%) than in group A (9%) ( P < 0.01). Conclusions: The introduction of sonographic based triage and therapeutic protocols for benign uterine lesions determined a dramatic reduction of demolitive uterine surgery, even in the same medical equipe. This involves a significant reduction of economic cost and an improvement in health care for the same abnormal conditions.