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

Abstract

Objective: Current urogynaecology practice allows preservation of the uterus in pelvic organ prolapse (POP) surgery, thus not reducing oncologic risk.

Cíl: The aim of the study was to evaluate the efficacy of ultrasound (USG) in diagnosis of 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. 

Design: Retrospective analysis

Setting: GPK LF UK a FN Plzeň.

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 excludedResults: 289 women were enrolled in the study (157(54.3%) expert USG vs. 132(45.7%) nonexpert USG). Abnormal findings were observed on the cervix in one case (nonexpert USG), the endometrium 30(10.4%) cases (13(8.3%) expert vs. 17(12.9%) nonexpert USG), the adnexa 3(2.3%) cases (all nonexpert USG), no suspicion of malignancy on myometrium was observed. USG was false negative in 4(1.4%) cases (2(1.3%) expert vs. 2(1.5%) nonexpert 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 finding was 87.2%. A sonographer specialized in oncologic sonography is able to reduce the number of false positive findings, however, does not increase the sensitivity of the ultrasound.