Objectives: The aim of this study was to investigate the accuracy of transvaginal sonography (TVS) and contrast-enhanced magnetic resonance-colonography (CE-MR-C) for the pre-surgical assessment of deep infiltrating endometriosis (DIE). Methods Ninety women were prospectively enrolled for a suspicion of DIE. All patients underwent a TVS and a CE-MR-C performed blindly, before laparoscopy. The sites of DIE examined by both imaging techniques were: recto-vaginal septum, pouch of Douglas, utero-sacral ligaments, vesico-uterine pouch, bowel, bladder and vagina. The presence of adhesions, the involvement of adnexa and of a previous abdominal scar, in case of a clinical suspicion, were also evaluated. TVS and CE-MR-C findings were compared with laparoscopic and histological results. Results Endometriosis was confirmed by laparoscopy in 95.6% of cases (86//90). In 82.2% (74/90) of patients there was DIE. The global accuracy, sensitivity, specificity, positive predictive values, negative predictive values, positive likelihood ratios and negative likelihood ratios were 89.2%, 81.1%, 94.2%, 89.6%, 89.0%, 13.9 and 0.2 for TVS, 87.2%, 71.1%, 97.1%, 93.7%, 84.6%, 24.4 and 0.3 for CE-MR-C. CE-MR-C allowed to diagnose all cases of bowel involvement; the accuracy for infiltration and stenosis was 100%. The accuracy of TVS for recto-sigmoid nodules and infiltration was 91.1% and 88.9%. Conclusions Both techniques showed satisfactory results. TVS appears a powerful, simple, feasible, cost effective tool for preoperative staging of DIE. CE-MR-C is an "X Ray free" technique, which could be reserved for cases with deep infiltrating rectosigmoid lesions, for the prediction of stenosis and involvement of the upper part of colon and small intestine. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

We read with interest the article by Mittal et al [1], “Diagnostic criteria for distinguishing endometrial adenocarcinoma from endometrial complex atypical hyperplasia”. The article is noteworthy not only for diagnostic aspects but also for clinical repercussions. We report our clinical experience on the diagnostic accuracy of hysteroscopy with regard to atypical endometrial hyperplasia. All hysteroscopies were performed using a continuous-flow office hysteroscope with a 5F working channel. The biopsy forceps has a diameter of 5F and jaws of 5 mm in length. The forceps features small teeth on both sides of the jaws to retain the obtained tissue. With the combination of this kind of forceps and adequate technique, a very large amount of biopsied endometrial tissue (mean, 5.7 mm2 measured in 2 dimensions on histologic section) was sampled [2]. We compared the hysteroscopic findings (including targeted biopsies) with the histologic findings obtained after hysterectomy. On the basis of histologic examination of endometrial biopsy during a period of 10 years, we had 29 cases of atypical endometrial hyperplasia. Of these, 14 cases (48.3%) were found to be endometrial carcinoma with atypical endometrial hyperplasia at the hysterectomy. All carcinomas were endometrioid carcinomas, except for 1 case of adenosquamous carcinoma. Endometrioid carcinomas were well differentiated except for 2 cases, which were poorly differentiated. The myometrial invasion was present in the inner third of the uterus in 2 cases of endometrioid carcinoma. In the 14 cases of endometrial carcinoma diagnosed by hysterectomy, the image-based diagnosis by hysteroscopy led to a suspicion of endometrial carcinoma. The biopsies did not confirm the suspicion but revealed an atypical endometrial hyperplasia. The problem may be due to the amount of the biopsy, even when properly executed, because it was performed in a targeted manner. In our clinical perspective, we appreciate all effort to establish morphological criteria in biopsies to distinguish endometrial adenocarcinoma from atypical endometrial hyperplasia. If there is any doubt and the operator has a suspicion of endometrial cancer, then we will definitely suggest the repetition of the biopsy: this is the peculiarity of hysteroscopy [3]. Other “blind” techniques of endometrial biopsy (dilatation and curettage, Novak, Vabra, Pipelle) cannot suggest any suspicion and, thereupon, cannot suggest any repetition of the biopsy.

OBJECTIVE: To investigate the contribution of contrast-enhanced MR-colonography (CE-MR-C) for the diagnosis of intestinal endometriosis. METHODS: One hundred and four women with suspected endometriosis were prospectively enrolled. All patients were subjected to MRI consisting of two phases: pelvic high-resolution MRI (HR-MRI) followed by CE-MR-C after colonic distension using a 1.5-liter water enema and injection of 0.15 ml/kg of 0.5 M gadolinium-DTPA with T1w high-resolution isotropic volume (THRIVE) and balanced turbo field echo (BTFE) images. HR-MRI and CE-MR-C were considered as two datasets, which were independently reviewed by two radiologists with 12 and 2 years' experience respectively. The presence of deep pelvic endometriotic lesions with particular attention to colorectal involvement was recorded. RESULTS: MRI findings correlated with laparoscopy in all cases. Thanks to CE-MR-C images, sensitivity, specificity, PPV, NPV and accuracy for diagnosis of colorectal endometriosis increased from 76%, 96%, 84%, 93% and 91%, to 95%, 97%, 91%, 99% and 97% for the most experienced radiologist and from 62%, 93%, 72%, 89% and 85%, to 86%, 94%, 82%, 96% and 92% for the less experienced radiologist; moreover, the interobserver agreement increased from 0.63 to 0.80 (Cohen's K test). CONCLUSION: CE-MR-C allows easier recognition of colorectal endometriosis and higher interobserver agreement.

Uterine abnormalities, including congenital pathologies, polyps, submucous leiomyomata, intrauterine adhesions, and chronic endometritis, have been reported in 21 to 47% of patients undergoing in vitro fertilization cycles. The position of hysteroscopy in current fertility practice is under debate. Although there are many randomized controlled trials on technical feasibility and patient compliance demonstrating that the procedure is well tolerated and effective in the treatment of intrauterine pathologies, there is no consensus on the effectiveness of hysteroscopic surgery in improving the prognosis of subfertile women. However, in patients with at least two failed cycles of assisted reproductive technology, diagnostic hysteroscopy and, if necessary, operative hysteroscopy is mandatory to improve reproductive outcome. Office hysteroscopy is a powerful tool for the diagnosis and treatment of intrauterine benign pathologies. It is a simple, safe, reproducible, effective, quick, well-tolerated, and low-cost surgical procedure, with no need for an operating room

A common anatomical consequence of low-segment cesarean section is the presence of a pouch on the anterior uterine wall that can be detected by sonography or hysteroscopy. Different suturing techniques have been compared (single vs double layer) and showed no substantial differences. This prospective longitudinal study was aimed at evaluating the outcome of the cesarean scar, comparing two different types of single-layer sutures by transvaginal ultrasound and hysteroscopy.

No abstract available