Elastography Improves the Diagnostic Accuracy of Sonography in Differentiating Endometrial Polyps and Submucosal Fibroids

Objectives-To assess whether strain elastography may be used to visualize the different stiffness of endometrial polyps and submucosal fibroids. Methods-We conducted a prospective monocentric single-operator study on diagnostic accuracy. Patients who qualified for hysteroscopy because of suspected endometrial polyps and submucosal fibroids were included. Before the procedure, all patients underwent routine sonographic and power Doppler examinations. Additionally, the stiffness of intrauterine lesions was assessed by strain elastography. The enhancement was adjusted to visualize hard myometrium and soft endometrium around the intrauterine lesion. Due to their histologic structure, we assumed that on strain elastography, endometrial polyps should appear as soft lesions, whereas submucosal fibroids should appear as hard lesions. Sonographic, power Doppler, and elastographic findings were verified by pathologic examinations after hysteroscopies. The diagnostic accuracy of sonography, power Doppler imaging, and strain elastography was compared by the McNemar test. Results-Forty-seven patients were included and underwent hysteroscopy. In 29 cases, endometrial polyps were found, and in 18, submucosal fibroids were found. The diagnostic accuracy rates for B-mode sonography, power Doppler imaging, and strain elastography in distinguishing endometrial polyps and submucosal fibroids were 70.2%, 65.9%, and 89.4%, respectively. The proportion of correct findings was significantly higher for strain elastography than for B-mode sonography (P=.0265) and power Doppler imaging (P=.0153). Conclusions-Strain elastography complements sonography in differentiating intrauterine lesions. Strain elastography may be used to visualize the different stiffness of endometrial polyps and submucosal fibroids.