Use of strict sonohysterographic methods for preoperative assessment of submucous myomas

Objective: To assess the diagnostic accuracy of sonohysterography (SHG) and transvaginal sonography versus diagnostic hysteroscopy in preoperative assessment of submucous myomas. Design: Prospective pilot study. Setting: University hospital outpatient center. Patient(s): Forty-eight symptomatic (bleeding, infertility) premenopausal patients with submucous myomas. Intervention(s): Preoperative grading of submucous myomas with a strict SHG methodology and standard transvaginal sonography compared with hysteroscopic grading of submucous myoma before hysteroscopic myomectomy. Main Outcome Measure(s): SHG and sonographic agreement with hysteroscopic findings. Result(s): Forty-eight patients were enrolled (mean age ± SD = 41 years ± 10.2). The median duration of SHG was 12 minutes (interquartile range, 9-16). The mean number of submucous myomas was 1 (range, 1-3) per woman. In all cases, a successful SHG was performed, with no, mild, or moderate pain in 38 (79%), 8 (17%), and 2 (4%) patients, respectively. No patients experienced severe pain or vasovagal reaction. All cases were correctly diagnosed by SHG compared with the final hysteroscopic diagnosis (κ = 1.0; SE = 0.105). Simple transvaginal ultrasound was inaccurate in six cases (κ = 0.81; SE = 0.103). Conclusion(s): Strict and reproducible SHG diagnostic procedures proved to be as effective as hysteroscopy and well tolerated in preoperative grading of submucous myomas.