Nineteen studies involving 2,917 women were included: 15 studies of premenopausal women (n=2,509) and 4 studies with combined data from pre- and postmenopausal women (n=408)).
The results presented in the paper were not always consistent between the text and tables. The results presented here were taken from the text.
Five studies were graded A, nine were graded B and five were graded C.
TVUS versus histopathology combined with hysteroscopy or hysterectomy.
Detection of any intrauterine pathology (10 studies, 4 grade A).
The results were not pooled because of heterogeneity. The sensitivity ranged from 46 to 100%, while the specificity ranged from 12 to 100%. The positive LRs ranged from 1.05 to 51.56 and the negative LRs from 0.07 to 0.79.
Detection of submucous fibroids (9 studies, 1 grade A). The results were not pooled because of heterogeneity. The sensitivity ranged from 21 to 100%, while the specificity ranged from 53 to 100%. The positive LRs ranged from 1.61 to 62.25 and the negative LR from 0.03 to 0.80.
Detection of endometrial hyperplasia or carcinoma (7 studies, 3 grade A).
The results were not pooled because of heterogeneity. The sensitivity ranged from 33 to 100%, while the specificity ranged from 79 to 99%. The positive LRs ranged from 2.59 to 679 and the negative LRs from 0.04 to 1.00. Cut-offs of 8 to 14 mm were used in the included studies.
When only studies graded A for quality were included, heterogeneity was still present for all outcomes except negative LRs for the outcome of endometrial hyperplasia or carcinoma (LR 0.05, 95% CI: 0.03, 0.10).
Sonohysterography versus histopathology.
Detection of all intrauterine pathologies (11 studies).
Heterogeneity was present for the following (data not pooled): sensitivity (range: 85 to 100%), specificity (range: 81 to 100%) and positive LRs (range: 1.96 to 80.0). The pooled negative LR was 0.12 (95% CI: 0.08, 0.18).
Detection of submucous fibroids (7 studies).
Heterogeneity was present for the following (data not pooled): sensitivity (range: 57 to 100%), specificity (range: 96 to 100%) and negative LRs (range: 0.06 to 0.47). The pooled positive LR was 29.6 (95% CI: 17.77, 49.60).
Detection of endometrial hyperplasia or carcinoma (4 studies).
The results were not pooled because of heterogeneity. The sensitivity ranged from 29 to 80%, while the specificity ranged from 82 to 100%. The positive LRs ranged from 1.55 to 70.40 and the negative LRs from 0.14 to 0.88.
A sensitivity analysis was not possible as only one study was graded A for quality.
Diagnostic hysteroscopy and biopsy versus reference standard.
Detection of all intrauterine pathologies (3 studies). Heterogeneity was present for the following (data not pooled): sensitivity (range: 90 to 97%), specificity (range: 62 to 93%) and positive LRs (range: 2.55 to 14.56). The pooled negative LR was 0.07 (95% CI: 0.04, 0.15).
Detection of submucous fibroids (4 studies).
Heterogeneity was present for the following (data not pooled): sensitivity (range: 53 to 100%), specificity (range: 97 to 100%) and negative LRs (range: 0.08 to 0.48). The pooled positive LR was 29.43 (95% CI: 13.26, 65.33).
Detection of endometrial hyperplasia or carcinoma (3 studies).
Heterogeneity was present for the following (data not pooled): sensitivity (range: 90 to 100%) and specificity (range: 97 to 100%). The pooled positive LR was 92.84 (95% CI: 47.0, 111.7) and the pooled negative LR was 0.05 (95% CI: 0.02, 0.12).
Patient discomfort.
One study of TVUS reported no cases of discomfort, while a second reported that 2% of patients found the procedure unpleasant and 40% felt slight pelvic pain.
Four studies using sonohysterography reported that some patients experienced discomfort. A fifth study reported that 13% of patients found the procedure unpleasant and 53% felt slight pelvic pain. In a sixth study, 97 of the 130 women reported no pain or acceptable discomfort, and one had barely tolerable pain. In a seventh study, 4 of the 50 patients had severe pain and all patients reported some pain.
One study using hysteroscopy reported that 13 of the 793 cases were not completed because of intolerance of the procedure, while 3.6% of women reported unacceptable pain. Another study found 50 of the 130 women had either tolerable or barely tolerable discomfort with this procedure.
Information on morbidity was reported infrequently.