Objective

The objective of this study was twofold. (1) To investigate the predictive characteristics of transvaginal ultrasonography for hysteroscopy necessity in Essure removal surgery. (2) To investigate the additional predictive value of a preoperative pelvic radiograph to transvaginal ultrasonography for hysteroscopy necessity.

Study Design

Retrospective cohort study, performed in an academic and a non-academic teaching hospital in the Netherlands. 71 women who underwent Essure removal surgery with a perioperative hysteroscopy and who had a preoperative pelvic X-ray and transvaginal ultrasound were included. Four experts first predicted hysteroscopy necessity based on transvaginal ultrasound description and secondly based on transvaginal ultrasound combined with the preoperative pelvic radiograph. Sensitivity, specificity, positive predictive value and negative predictive value of the predictive tests were calculated.

Results

Based on transvaginal ultrasound, the mean predictive characteristics for experts were: sensitivity 89.7% (range 66.7%–100%), specificity 37.4% (range 17.6%–67.7%), positive predictive value 18.8% (range 13.2%–29.5%) and negative predictive value 95.1% (range 86.1%–100%). After adding the pelvic radiograph to the transvaginal ultrasound descriptions, the results were: sensitivity 66.7% (range 53.3%–80%), specificity 72.6% (range 56%–97.3%), positive predictive value 23% (range 14.3%–26.9%) and negative predictive value 94.1 % (range 90.3%–98.4%). For three experts sensitivity decreased after adding the pelvic radiograph. For all experts specificity increased.

Conclusion

It is difficult to preoperatively decide if the fourth marker of the Essure outer coil can be excised during hysteroscopy. The addition of pelvic radiography to transvaginal ultrasound is not beneficial. It is recommended to perform a hysteroscopy during Essure removal surgery.

中文翻译：

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Essure 去除手术：是否需要术前经阴道超声和盆腔 X 光检查？

客观的

这项研究的目的是双重的。(1) 探讨经阴道超声对子宫内膜切除术中宫腔镜检查必要性的预测特征。(2) 研究术前盆腔 X 线片对经阴道超声检查对宫腔镜必要性的额外预测价值。

学习规划

在荷兰的一家学术和非学术教学医院进行的回顾性队列研究。纳入了 71 名接受了围手术期宫腔镜检查并接受过盆腔 X 光检查和经阴道超声检查的 Essure 切除手术的女性。四位专家首先根据经阴道超声描述预测宫腔镜检查的必要性，其次根据经阴道超声结合术前盆腔X线片预测宫腔镜检查的必要性。计算预测测试的敏感性、特异性、阳性预测值和阴性预测值。

结果

基于经阴道超声，专家的平均预测特征为：敏感性 89.7%（范围 66.7%–100%），特异性 37.4%（范围 17.6%–67.7%），阳性预测值 18.8%（范围 13.2%–29.5%）阴性预测值为 95.1%（范围 86.1%–100%）。在经阴道超声描述中加入盆腔片后，结果为：敏感性 66.7%（范围 53.3%–80%），特异性 72.6%（范围 56%–97.3%），阳性预测值 23%（范围 14.3%–26.9 %) 和阴性预测值 94.1 %（范围 90.3%–98.4%）。对于三位专家，添加骨盆 X 光片后敏感性降低。对于所有专家，特异性都增加了。

结论

术前很难确定是否可以在宫腔镜检查期间切除 Essure 外线圈的第四个标记。经阴道超声联合盆腔 X 线检查并无益处。建议在 Essure 切除手术期间进行宫腔镜检查。