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:
https://doi.org/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
Sources
1. Wilcox LS, Koonin LM, Pokras R et al. Hysterectomy in the United States, 1988–1990. Obstet Gynecol 1994; 83 (4): 549–555. doi: 10.1097/00006250-199404000-00011.
2. Osborn DJ, Reynolds WS, Dmochowski R et al. Vaginal approaches to pelvic organ prolapse repair. Curr Opin Urol 2013; 23 (4): 299–305. doi: 10.1097/MOU.0b013e3283619e1a.
3. Hemming C, Constable L, Goulao B et al. Surgical interventions for uterine prolapse and for vault prolapse: the two VUE RCTs. Health Technol Assess 2020; 24 (13): 1–220. doi: 10.3310/hta24 130.
4. Nygaard I, Brubaker L, Zyczynski HM et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA 2013; 309 (19): 2016–2024. doi: 10.1001/ jama.2013.4919.
5. Kalis V, Smazinka M, Rusavy Z et al. Laparoscopic sacrocolpopexy as the mainstay management for significant apical pelvic organ prolapse (LAP) study. Eur J Obstet Gynecol Reprod Biol 2020; 244: 60–65. doi: 10.1016/j.ejogrb.2019.10.049.
6. Smazinka M, Kalis V, Havir M et al. Obesity and its long-term impact on sacrocolpopexy key outcomes (OBELISK). Int Urogynecol J 2020; 31 (8): 1655–1662. doi: 10.1007/s00192-019-04076-8.
7. Gagyor D, Kalis V, Smazinka M et al. Pelvic organ prolapse and uterine preservation: a cohort study (POP-UP study). BMC Womens Health 2021; 21 (1): 72. doi: 10.1186/s12905-021-01208-5.
8. Pan K, Cao L, Ryan NA et al. Laparoscopic sacral hysteropexy versus laparoscopic sacrocolpopexy with hysterectomy for pelvic organ prolapse. Int Urogynecol J 2016; 27 (1): 93–101. doi: 10.1007/s00192-015-2775-9.
9. Tolstrup CK, Lose G, Klarskov N. The Manchester procedure versus vaginal hysterectomy in the treatment of uterine prolapse: a review. Int Urogynecol J 2017; 28 (1): 33–40. doi: 10.1007/s00192-016-3100-y.8.
10. Kalis V, Rusavy Z, Ismail KM. Laparoscopic sacrohysteropexy: the Pilsner modification. Int Urogynecol J 2020; 31 (6): 1277–1280. doi: 10.1007/s00192-019-04150-1.
11. Urdzík P, Kalis V, Blaganje M et al. Pelvic organ prolapse and uterine preservation: a survey of female gynecologists (POP-UP survey). BMC Womens Health 2020; 20 (1): 241. doi: 10.1186/s12905-020-01105-3.
12. Yen JY, Chen YH, Long CY et al. Risk factors for major depressive disorder and the psychological impact of hysterectomy: a prospective investigation. J Psychosomatics 2008; 49 (2): 137–142. doi: 10.1176/appi.psy.49.2.137.
13. Anastasiadis P, Koutlaki N, Skaphida P et al. Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding. Eur J Gynaecol Oncol 2000; 21 (2): 180–183.
14. Dreisler E, Stampe Sorensen S, Ibsen PH et al. Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20–74 years. Ultrasound Obstet Gynecol 2009; 33 (1): 102–108. doi: 10.1002/uog.6259.
15. Begum J, Samal R. A clinicopathological evaluation of postmenopausal bleeding and its correlation with risk factors for developing endometrial hyperplasia and cancer: a hospital-based prospective study. J Midlife Health 2019; 10 (4): 179–183. doi: 10.4103/jmh.JMH_136_18.
16. Srikrishna S, Robinson D, Cardozo L et al. Is transvaginal ultrasound a worthwhile investigation for women undergoing vaginal hysterectomy? J Obstet Gynaecol 2008; 28 (4): 418–420. doi: 10.1080/01443610802149954.
17. Grigoriadis T, Valla A, Zacharakis D et al. Vaginal hysterectomy for uterovaginal prolapse: what is the incidence of concurrent gynecological malignancy? Int Urogynecol J 2015; 26 (3): 421–425. doi: 10.1007/s00192-014-2516-5.
18. Ackenbom MF, Giugale LE, Wang Y et al. Incidence of occult uterine pathology in women undergoing hysterectomy with pelvic organ prolapse repair. Female Pelvic Med Reconstr Surg 2016; 22 (5): 332–335. doi: 10.1097/SPV.000000 0000000283.
19. Frick AC, Walters MD, Larkin KS et al. Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovagi- nal prolapse. Am J Obstet Gynecol 2010; 202 (5): 507.e1–504.e1. doi: 10.1016/j.ajog.2010.01.077.
20. Renganathan A, Edwards R, Duckett JR. Uterus conserving prolapse surgery – what is the chance of missing a malignancy? Int Urogynecol J 2010; 21 (7): 819–821. doi: 10.1007/ s00192-010-1101-9.
21. Andy U, Nosti P, Kane Set al. Incidence of unanticipated uterine pathology at the time of minimally invasive abdominal sacrocolpopexy. J Minim Invasive Gynecol 2014; 21 (1): 97–100. doi: 10.1016/j.jmig.2013.07.008.
22. Mizrachi Y, Tannus S, Bar J et al. Unexpected significant uterine pathological findingsat vaginal hysterectomy despite unremarkable preoperative workup. Isr Med Assoc 2017; 19 (10): 631–634.
23. Van den Bosch T, Van Schoubroeck D, Domali E et al. A thin and regular endometrium on ultrasound is very unlikely in patients with endometrial malignancy. Ultrasound Obstet Gynecol 2007; 29 (6): 674–679. doi: 10.1002/uog.4031.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2022 Issue 1
Most read in this issue
- Pregnancy outcome prediction after embryo transfer based on serum human chorionic gonadotrophin concentrations
- Hand-foot-mouth disease in puerperium
- Accuracy of the Edinburgh Postnatal Depression Scale in screening for major depressive disorder and other psychiatric disorders in women towards the end of their puerperium
- Indocyanine green as a new trend in sentinel lymphatic node detection in oncogynecology