Transvaginal Ultrasonography And Hysteroscopy Diagnosis Of Common Intrauterine Lesions In Patients With Infertility And Compare The Methods

Objective:(1) to investigate the incidence of infertility patients with common intrauterine lesions;(2) to compare two methods of inspection, check process optimization, reduce the traumatic operations.Methods:Analysis from February2014to March2014to our hospital300cases of infertility patients, all patients have transvaginal sonography (TVS) and hysteroscopy (Hs), and histopathology. The intrauterine lesions were compared, analyzed two methods of sensitivity, specificity, Youden index, positive likelihood ratio, negative likelihood ratio, the rate of omission diagnostic, misdiagnosis rate, compliance rate, kappa value, positive predictive value, negative predictive value.Results:(1)300cases of patients with a final diagnosis of infertility: combining pathological examination, the incidence of various diseases were:endometrial polyps29.33%; intrauterine adhesions19.0%; uterine malformation11.33%; intimal dysplasia3.0%; simple chronic nonspecific Straight endometrial inflammation2.67%; merger the other uterine disorders and chronic non-specific inflammation of the lining of12.0%; submucosal fibroids1.33%; endometrial tuberculosis0.67%. The results showed that the highest incidence of endometrial polyps, followed by intrauterine adhesions, the lowest incidence of endometrial tuberculosis.(2) For the diagnostic evaluation of endometrial polyps:two methods authenticity indicators sensitivity index were85.23%,87.5%; specificity of98.58%,98.58%; omission diagnostive rate of14.17%,12.5%; misdiagnosis rate of1.42%,1.42%; Youden index of84.3%, 86.8%; positive likelihood ratio60.23,61.83; negative likelihood ratio0.15,0.13, sensitivity, specificity are high, with high diagnostic value. Reliability index:compliance rates were94.67%,95.33%, are high, and reliability; Kappa value (k)0.884,0.915, consistency is better. Income indicators:positive predictive values were96.15%,96.25%; negative predictive value94.14%,95.0%, higher, better income. There was no statistically significant difference (x2=10.08, p>0.0125) in line with the rate of two methods.(3) Endometrial hyperplasia endometrial abnormalities diagnostic evaluation:the authenticity of the two methods sensitivity index were33.33%,77.78%; specificity of97.66%,98.28%; omission diagnostic rate of66.77%,22.22%; misdiagnosis rate of0.34%,1.72%; Youden index32.99%,76.06%; positive likelihood ratio97,45.27; negative likelihood ratio0.67,0.23. Reliability index: compliance rates were97.67%,97.67%; Kappa value (k)0.451,0.615, in highly consistent. Income indicators:positive predictive value was75%,58.33%; negative predictive value97.97%,99.31%. Comparison of two methods no coincidence rate (x2=4.083, p>0.0125) statistically significant.(4) Uterine fibroids under the mucous membrane of the diagnostic evaluation:the authenticity of the two methods sensitivity index were50.0%,75.0%; specificity of97.97%,97.97%; omission diagnostic rate of50.0%,25%; misdiagnosis rate of2.03%,2.03%; Youden index47.97%,72.97%; positive likelihood ratio148,222; negative likelihood ratio0.5,0.25. Reliability index:compliance rate was99%,99.33%; Kappa value (k)0.566,0.747, in highly consistent. Income indicators:positive predictive value was66.67%,75%; negative predictive value99.31%,99.31%. Comparison of two methods consistent rate without significant difference (x2=0, p>0.0125).(5) For the chronic non-specific endometritis diagnostic evaluation:two methods authenticity sensitivity index were37.5%,87.5%; specificity of99.66%,99.32%; omission diagnostic rate was62.5%,12.5%; misdiagnosis rate of0.34%,0.68%; Youden index37.16%,86.82%; positive likelihood ratio109.5,127.75; negative likelihood ratio0.63,0.13. Reliability index: compliance rates were98%,99%; Kappa value (k)0.566,0.747, in highly consistent. Income indicators:positive predictive value was66.67%,75%; negative predictive value of49.1%,81.8%. There was no statistically significant difference (x2=1.78, p>0.0125) in line with the rate of two methods.(6) Transvaginal ultrasound diagnosis of intrauterine adhesions: authenticity indicators sensitivity52.63%, specificity99.18%,47.37%rate of omission diagnosis, misdiagnosis rate of0.82%, Youden index51.81%, positive likelihood ratio63.95, negative likelihood ratio of0.48, specificity high misdiagnosis rate. Reliability index:compliance rate of90.33%, Kappa values (k)0.623, in highly consistent. Income indicators: positive predictive value was93.75%,89.93%and negative predictive value are high, good income.(7) Transvaginal ultrasound diagnosis of uterine malformations:authenticity indicators sensitivity70.59%, specificity97.74%,29.41%rate of omission diagnosis, misdiagnosis rate of3.26%, Youden index68.33%, positive likelihood ratio31.29, negative likelihood ratio of0.3, a high degree of specificity misdiagnosis rate. Reliability index:compliance rate of94.67%, Kappa values (k)0.72, in highly consistent. Income indicators:positive predictive value80%, negative predictive value of96.3%, are high, good income.Conclusions:(1) This study suggests that infertility patients within a variety of intrauterine lesions highest incidence of endometrial polyps; followed by intrauterine adhesions, uterine malformations and the chronic non-specific endometrial meningitis; rare uterine intimal dysplasia, submucosal fibroids, endometrial tuberculosis.(2) Transvaginal ultrasound in the diagnosis of endometrial polyps, intrauterine adhesions, in the targets are high, most conducive to clinical work, the best gains. As has been ruled out in the short term pathology of malignant lesions, vaginal ultrasound may be preferred to reduce invasive procedures. But while hysteroscopic uterine malformations require assistance, in order to improve the diagnostic yield.(3) Abnormal uterine hyperplasia, chronic nonspecific endometritis, no significant difference between the two methods, but hysteroscopy can locate drawn and combined pathology, significantly better than vaginal ultrasound.