Accuracy of transvaginal ultrasound, saline infusion sonohysterography, and office hysteroscopy in the diagnosis of endometrial polyps

Background: Endometrial polyps (EPs) derive from overgrowths of stromal or endometrial glands supported by a fibrovascular core. Currently, there is no clear recommendation on the first-line tool to be employed between sonohysterography (SIS) and office hysteroscopy (ISC) in the evaluation of patients with the suspect of EPs. Materials and Methods: The authors performed a retrospective study on consecutive patients referred at their Unit with a suspicion of EP at transvaginal sonography (TVS). A total number of 1,243 patients were subject to TVS and ISC, while 128 ones were subject to TVS, SIS, and ISC. Primary outcome was the evaluation of the diagnostic performance of SIS and ISC in the detection of EPs. Results: ISC allowed the identification of EPs in all the cases (n=128/128 patients), with a sensitivity of 100% and specificity of 98%. For SIS, the sensitivity was 97% (n=124/128 patients) and specificity was 90%. Conclusions: ISC showed better diagnostic accuracy in comparison to SIS. Due to high diagnostic accuracy and the possibility to "see and treat" EPs in a single step, ISC should be considered as the gold standard approach in women with a suspect of EPs.