Clinical Study

Diagnostic hysteroscopy is more accurate than SIS and TVUS in assessing endometrial pathology

Grimbizis GF, Tsolakidis D, Mikos T, et al. Fertil Steril. 2010; 94:2721-2725.

A study of 105 women compared diagnostic hysteroscopy (DH), saline infusion sonohysterography (SIS), and transvaginal ultrasound (TVUS) in the assessment of endometrial pathology.

  • DH was the most accurate technique in the diagnosis of all endometrial pathologies (AUC=0.953) vs SIS (AUC=0.759) and TVUS (AUC=0.725)
  • DH had superior diagnostic performance vs. SIS (P<.001) and TVUS (P<0.001)
  • DH more accurately diagnosed endometrial diseases and intracavitary masses

Additionally, diseases of the endometrium (eg, hyperplasia and cancer) cannot be distinguished by SIS or TVUS.

Comparison of TVUS,
SIS, DH – Study

Click to View Disease State Results
  • aAny Path
  • bMyomas/Polyps
  • cMyomas
  • dPolyps
  • eDiseases
  • fStruc. Abnorm.

“This handheld, portable system can be set up in minutes and in any examination room, so it is not disruptive to my practice or my patients.”

Ethan Goldstein, MD
  • Ethan Goldstein, MD
  • Robotic & Minimally Invasive Surgery Program
  • Huron Valley-Sinai Hospital, Detroit, MI
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“Endosee brought about a mind-set change. By using it, you realize that you’re doing patients a service by getting to a diagnosis as soon as possible.”

Ethan Goldstein, MD
  • Ethan Goldstein, MD
  • Robotic & Minimally Invasive Surgery Program
  • Huron Valley-Sinai Hospital, Detroit, MI
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“In addition to offering physicians immediate visualization to gather important diagnostic information, Endosee also allows us to perform an endometrial biopsy and hysteroscopy in the same visit.”

Ethan Goldstein, MD
  • Ethan Goldstein, MD
  • Robotic & Minimally Invasive Surgery Program
  • Huron Valley-Sinai Hospital, Detroit, MI
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“Dramatic shifts within the Centers for Medicare & Medicaid Services fee schedule in 2017 – and commensurate changes in the private insurance market – have now ramped up [the value of in-office hysteroscopy]… According to national payment amounts, performing this procedure in the office earned an average of $1,382.07 in 2017, compared with $409.60 in 2016.”

Aarathi Cholkeri-Singh, MD
  • Aarathi Cholkeri-Singh, MD
  • University of Illinois, Chicago, IL
  • Advocate Lutheran General Hospital, Park Ridge, IL
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“The benefits of integrating hysteroscopy into office practice have been compelling for some time. An in-office approach is patient centered, more efficient, and clinically valuable. It also has had the potential to be economically valuable for practices that are able to perform a mix of diagnostic and therapeutic/operative hysteroscopies.”

Aarathi Cholkeri-Singh, MD
  • Aarathi Cholkeri-Singh, MD
  • University of Illinois, Chicago, IL
  • Advocate Lutheran General Hospital, Park Ridge, IL
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“In addition to reimbursement levels, it’s important to consider the efficiencies of in-office hysteroscopy. The setup is relatively simple and requires a dedicated exam room, not a surgical suite... Hysteroscopy at the hospital, or even at an ambulatory surgical center, involves time driving, changing, and waiting for anesthesia.”

Aarathi Cholkeri-Singh, MD
  • Aarathi Cholkeri-Singh, MD
  • University of Illinois, Chicago, IL
  • Advocate Lutheran General Hospital, Park Ridge, IL
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“For our patients… an in-office approach offers less out-of-pocket expense (deductibles), less time away from family/work, avoidance of general anesthesia/intubation, and greater patient comfort from being within a familiar environment. For diagnostic procedures, the patient can be in and out in less than 30 minutes, and for operative procedures, she can be in and out in 1-2 hours, compared with more than 4 hours at the hospital.”

Aarathi Cholkeri-Singh, MD
  • Aarathi Cholkeri-Singh, MD
  • University of Illinois, Chicago, IL
  • Advocate Lutheran General Hospital, Park Ridge, IL
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“[Before January, 2017,] higher procedural costs in the office…actually discouraged the physician who wanted to perform cases in the office. [The] increase in the reimbursement for hysteroscopic endometrial biopsy and/or polypectomy…creates a distinct monetary advantage, which along with increased physician efficiency and patient comfort, has led to more physicians bringing these surgeries to an in-office setting.”

Charles E. Miller, MD
  • Charles E. Miller, MD
  • University of Illinois, Chicago, IL
  • Lutheran General Hospital, Park Ridge, IL
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“No longer is hysteroscopy considered experimental or of dubious value. My hysteroscope is my stethoscope. It allows me to evaluate myriad gynecologic conditions: infertility, endometrial polyps, heavy menstrual bleeding, irregular menstrual cycles, equivocal findings on transvaginal ultrasound and imaging, postmenopausal bleeding, leukorrhea, intracavitary leiomyoma, retained products of conception, post-operative healing after Asherman’s, myomectomy, and foreign bodies.”

Linda Bradley
  • Linda Bradley
  • Professor of Surgery at Cleveland Clinic
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