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The Sonohysterographic Difference in Submucosal Uterine Fibroids and Endometrial Polyps Treated by Hysteroscopic Surgery

Department of Obstetrics and Gynecology, School of Medicine, Fukuoka University, Fukuoka, Japan.

Address correspondence to Makoto Emoto, MD, PhD, Department of Obstetrics and Gynecology, School of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan. E-mail: emoto{at}cis.fukuoka-u.ac.jp

Objective. The purpose of this study was to clarify the differences in sonohysterographic (SHG) findings between submucosal uterine fibroids and endometrial polyps treated by surgical hysteroscopy. Methods. Eighty patients with intrauterine benign masses without any endometrial cytologic atypia were examined by SHG before undergoing surgical hysteroscopy. The SHG images in these masses were assessed for the following characteristics: size, number, location, echogenicity, and degree of projection into the uterine cavity. The SHG findings were then compared with their hysteroscopic findings. The feeding vessels into these masses were also assessed by transvaginal color Doppler sonography in 26 of the 80 patients. Results. In all 80 patients, 47 histopathologically had submucosal fibroids, whereas the remaining 33 had endometrial polyps. Masses measuring greater than 20 mm were significantly more frequently fibroids than polyps (P < .01). Homogeneous hyperechoic masses were significantly seen in polyps (93.9% [31/33]; P < .01) but not in any fibroids except for 1 case. Multiple feeding vessels were significantly found in fibroids (12/15; P < .01), whereas they were not found in any of the 11 polyps examined. The location and degree of projection into the uterine cavity of these masses as assessed by SHG were consistent with their hysteroscopic findings in 78 (97.5%) of 80 patients. The foci of endometrial hyperplasia were significantly found in 5 (15.2%) of 33 polyps (P < .01), whereas no such tissues were obtained in any fibroids. Conclusions. Intracavitary fibroids tend to be larger than the polyps, and homogeneous hyperechoic masses in the uterine cavity observed by SHG are highly suggestive of endometrial polyps.

Key Words: endometrial hyperplasia • endometrial polyp • hysteroscopy • sonohysterography • uterine fibroid

Abbreviations: SHG, sonohysterography

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