Optimal Timing of Transvaginal Ultrasound to Diagnose Endometrial Polyps in Women with Abnormal Uterine Bleeding.

Introduction Abnormal uterine bleeding (AUB) is the most common symptom of the endometrial polyps in fertile and postmenopausal women. This study aimed to determine the optimal time to perform a transvaginal ultrasound to diagnose endometrial polyps in the women with abnormal uterine bleeding (AUB).

This descriptive study from the category of a follow-up study was conducted on 350 a group of fertile women with AUB that referred to a women’s clinic in Jahrom, Southern Iran. The women with abnormal uterine bleeding at the women’s clinic underwent transvaginal sonography. The research included patients who had endometrial polyps discovered during the sonography. Transvaginal sonography was performed on each patient once in the luteal and once in the follicular phases. A hysteroscopy was then conducted in order to get an accurate diagnosis. The collected data were analyzed using SPSS software version 18. The receiver operating characteristic (ROC) curve was used to determine the optimal time to perform the ultrasound to diagnose endometrial polyps.

Among the women in the study, 88.8% (310 participants) were multiparous, and endometrial polyps were detected in 47.4% (166 patients) with the transvaginal sonography of the women. Finally, endometrial polyps were confirmed for 107 patients (64.45%) with hysteroscopy. ROC curve analysis showed that the optimal time to diagnose the endometrial polyps with transvaginal ultrasound was on days 11–13 of the menstrual cycle during the follicular phase, with a sensitivity of 82.5% and a specificity of 73%.

By designating days 11–13 of the follicular phase of the menstrual cycle as the ideal time to utilize transvaginal ultrasound for the purpose of diagnosing endometrial lesions, it is possible to reduce errors and enhance the accessibility of treatment and diagnosis. This study provides essential information for clinicians to identify the endometrial polyps in the women with AUB. Similar content being viewed by others Data Availability The authors recognize that the article contains the necessary data to support the findings presented in this research. Abbreviations - AUB: - Abnormal uterine bleeding - SPSS: - Statistical Package for the Social Sciences - ROC curve: - Receiver operating characteristic curve - TVS: - Transvaginal ultrasound - PPV: - Positive predictive value - NPV: - Negative predictive value - AUC: - Area under the curve - D&C: - Dilatation and curettage - SIS: - Saline infusion sonography

Kanthi JM, Remadevi C, Sumathy S, et al. Clinical study of endometrial polyp and role of diagnostic hysteroscopy and blind avulsion of polyp. J Clin Diagn Res. 2016;10(6):QC01. Meena J, Manchanda R, Kulkarni S, et al. Story of a giant endometrial polyp in asymptomatic postmenopausal female. J Clin Diagn Res. 2017;11(3):06. Shang M, Zhang W. Predictive factors of endometrial lesions in patients with abnormal uterine bleeding. Eur J Obstet Gynecol Reprod Biol. 2023;288:67–72. Anastasiadis PG, Koutlaki NG, Skaphida PG, et al. Endometrial polyps: Prevalence, detection, and malignant potential in women with abnormal uterine bleeding. Eur J Gynaecol Oncol. 2000;21(2):180–3. 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):102–8. Evans AJTO. Re. The management of endometrial polyps in the 21st Century. Obstet Gynaecol. 2013;15(4):280–1. Pereira N, Petrini AC, Lekovich JP, et al. Surgical management of endometrial polyps in infertile women: A comprehensive review. Surg Res Pract. 2015. https://doi.org/10.1155/2015/914390. Mansour T, Chowdhury YS. Endometrial polyp. StatPearls [Internet]: StatPearls Publishing; 2023. Uglietti A, Buggio L, Farella M, et al. The risk of malignancy in uterine polyps: A systematic review and meta-analysis. Eur J Obstet Gyneco Reprod Biol. 2019;237:48–56. Costa-Paiva L, Godoy CE Jr, Antunes A Jr, et al. Risk of malignancy in endometrial polyps in premenopausal and postmenopausal women according to clinicopathologic characteristics. Menopause. 2011;18(12):1278–82. Worldwide AAMIGJJoMIG. AAGL practice report: Practice guidelines for the diagnosis and management of endometrial polyps. 2012; 19(1): 3–10. Nijkang NP, Anderson L, Markham R, et al. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med. 2019;7:2050312119848247. Naredi N, Sharma R, Gurmeet P. Can three-dimensional transvaginal sonography replace office hysteroscopy in detecting uterine abnormalities in infertility patients? J Hum Reprod Sci. 2021;14(4):392–9. Naz F, Ahmed A, Shaikh S et al. Diagnostic accuracy of hysterosonography in diagnosis of uterine lesions by taking hysteroscopy as gold standard. 49: 45.4 Makris N, Kalmantis K, Skartados N, et al. Three-dimensional hysterosonography versus hysteroscopy for the detection of intracavitary uterine abnormalities. Int J Gynecol Obstet. 2007;97(1):6–9. Zhu H, Fu J, Lei H, et al. Evaluation of transvaginal sonography in detecting endometrial polyps and the pregnancy outcome following hysteroscopic polypectomy in infertile women. Exp Ther Med. 2016;12(2):1196–200. Ciscato A, Zare SY, Fadare O. The significance of recurrence in endometrial polyps: A clinicopathologic analysis. Hum Pathol. 2020;100:38–44. AlHilli MM, Nixon KE, Hopkins MR, et al. Long-term outcomes after intrauterine morcellation vs hysteroscopic resection of endometrial polyps. J Minim Invasive Gynecol. 2013;20(2):215–21. Yang JH, Chen CD, Chen SU, et al. Factors influencing the recurrence potential of benign endometrial polyps after hysteroscopic polypectomy. PloS one. 2015;10(12):e0144857. Kanthi JM, Remadevi C, Sumathy S, et al. Clinical study of endometrial polyp and role of diagnostic hysteroscopy and blind avulsion of polyp. J Clin Diagn Res. 2016;10(6):QC01-4. Ragni G, Diaferia D, Vegetti W, et al. Effectiveness of sonohysterography in infertile patient work-up: A comparison with transvaginal ultrasonography and hysteroscopy. Gynecol Obstet Invest. 2005;59(4):184–8. Valenzano MM, Lijoi D, Mistrangelo E, et al. The value of sonohysterography in detecting intracavitary benign abnormalities. Arch Gynecol Obstet. 2005;272(4):265–8. Barboza IC, Depes Dde B, Vianna Júnior I, et al. Analysis of endometrial thickness measured by transvaginal ultrasonography in obese patients. Einstein (Sao Paulo). 2014;12(2):164–7. Hajishaiha M, Ghasemi-Rad M, Karimpour N, et al. Transvaginal sonographic evaluation at different menstrual cycle phases in diagnosis of uterine lesions. Int J Womens Health. 2011;3:353–7. Morita T, Nishijima T, Tokura H. Time sense for short intervals during the follicular and luteal phases of the menstrual cycle in humans. Physiol Behav. 2005;85(2):93–8. Nijkang NP, Anderson L, Markham R, et al. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med. 2019;7:2050312119848247. Niknejadi M, Haghighi H, Ahmadi F, et al. Diagnostic accuracy of transvaginal sonography in the detection of uterine abnormalities in infertile women. Iran J Radiol. 2012;9(3):139. Kutlucan H, Işık G, Cevher Akdulum M, et al. 7 Comparison of two-dimensional (2d) transvaginal ultrasound, three-dimensional (3d) ultrasound and hysteroscopy to diagnose in patients with abnormal uterine bleeding. Eur J Obstet Gynecol Reprod Biol. 2022;270:e29.

The present study was conducted as part of a Medical Doctor thesis at Jahrom University of Medical Sciences, which studied the optimal timing of transvaginal ultrasound to diagnose endometrial polyps. We want to express our gratitude to all the participants who participated in the study, and the Vice President of Health at Jahrom University of Medical Sciences for their valuable support and assistance in conducting the research. Their contributions were greatly appreciated and instrumental in completing this study. Funding We acknowledge that the Research Deputy of Jahrom University of Medical Sciences, Iran, funded this study. The Research Deputy’s financial assistance did not, it is imperative to stress, have any impact on the study’s design, data collection, analysis, or interpretation. The study Deputy provided just financial assistance and was not involved in any part of the study process. The study findings and results were solely based on the data collected and analyzed by the research team and were not influenced by external factors. Author information Authors and Affiliations Contributions AR and TKH were involved in the study design and planning. MA and MJ conducted the literature search and screening. AR and TKH were responsible for data collection, while VR participated in the statistical analysis. AR, TKH, and MA contributed to data interpretation. The manuscript was drafted by VR, MJ, and AR, with VR critically revising the manuscript. All authors have read and approved the final manuscript for publication. VR had full access to all data in this study and took complete responsibility for the integrity, and accuracy of the data analysis. Corresponding author Ethics declarations Conflict of interest The authors declare that they have no competing interests. Ethical Approval Before the start of the study, all participants were fully informed about the aim of the research, and the details of their involvement were explained to them. Participants were assured that the researcher would keep their personal information confidential. The study was conducted with the approval of the Vice Chancellor for Research of Jahrom University of Medical Sciences (Ethical Code IR.JUMS.REC.1396.077), and written informed consent was obtained from all participants. Consent for Publication Not applicable. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Athar Rasekh Jahromi is a Obstetrics and Gynecologist; Hamideh Ebadat is a Radiologist; Mohammad Jokar is a DVM; Nikta Taghipour is a Student Research Committee and Vahid Rahmanian is a Assistant professor in Epidemiology. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Rasekh Jahromi, A., Ebadat, H., Jokar, M. et al. Optimal Timing of Transvaginal Ultrasound to Diagnose Endometrial Polyps in Women with Abnormal Uterine Bleeding. J Obstet Gynecol India 75 (Suppl 1), 62–69 (2025). https://doi.org/10.1007/s13224-024-01993-7 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s13224-024-01993-7