Contribution of ultrasound examination in the detection of unexpected uterine and adnexal findings in reconstructive surgery for pelvic organ prolapse


Authors: Smažinka M.;  Havíř M.;  Rušavý Z.;  Vlasák P.;  Kovářová V.;  Veverková A.;  Ismail M. K.;  Kališ V.
Authors‘ workplace: Gynekologicko-porodnická klinika LF UK a FN Plzeň
Published in: Ceska Gynekol 2022; 87(1): 13-18
Category: Original Article
doi: 10.48095/cccg202213

Overview

 Objective: Current urogynaecology practice allows preservation of the uterus in pelvic organ prolapse (POP) surgery, thus not reducing oncologic risk. Aim: The aim of the study was to evaluate the efficacy of ultrasound (USG) in dia­gnosing unexpected uterine and adnexal pathologies in women referred for POP. Furthermore, the benefit of USG examination by a specialist in gynaecology-oncology ultrasound was assessed. Materials and methods: All women after a hysterectomy with or without adnexectomy in the course of a POP surgery at our tertiary centre in 2013–2018 with preoperative USG were enrolled in the study. Women with recurrent uterine bleeding, abnormal cytology, using tamoxifen, or women with already dia­gnosed uterine or adnexal pathology were excluded. Results: 289 women were enrolled in the study – 157 (54.3%) expert USG vs. 132 (45.7%) non-expert USG. Abnormal findings were observed on the cervix in one case (non-expert USG), the endometrium 30 (10.4%) cases – 13 (8.3%) expert vs. 17 (12.9%) non-expert USG, the adnexa three (2.3%) cases (all non-expert USG), and no suspicion of malignancy on myometrium was observed. USG was false negative in four (1.4%) cases – two (1.3%) expert vs. two (1.5%) non-expert USG. Conversely, the examination was false positive in 34 (11.8%) cases – 13 (8.3%) expert vs. 21 (15.9%) non-expert USG. Conclusion: The risk of unexpected uterine or adnexal pathologies in POP surgery was 1.4%. The agreement between USG and histopathological benign, abnormal or malign findings was 87.2%. A sonographer specialized in oncologic sonography is able to reduce the number of false positive findings; however, this does not increase the sensitivity of the ultrasound.

Keywords:

tumor – malignancy – pelvic organ prolapse – specialised oncological sonography


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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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