Diagnostic accuracy of transabdominal and transvaginal ultrasound in the combined diagnosis of endometrial polyps: a retrospective observational study

BACKGROUND: Endometrial polyps (EP) are common benign lesions that require early and accurate diagnosis. Hysteroscopy, considered the gold standard, is invasive; although transvaginal ultrasonography (TVUS) is the preferred initial imaging modality, its diagnostic performance warrants systematic evaluation. This study aimed to compare different application modalities of TVUS in the diagnosis of EP. RESEARCH DESIGN AND METHODS: We retrospectively enrolled 109 patients with suspected EP (January 2022-July 2024). All underwent preoperative transabdominal sonography (TAS) and two-dimensional TVUS (2D-TVUS). Using hysteroscopy plus histopathology as reference, we compared TAS, 2D-TVUS, and their combination for sensitivity (Sen), specificity (Spe), positive predictive value (PPV), negative predictive value (NPV), accuracy (Acc), and Kappa. RESULTS: The confirmed diagnosis rate of EP was 84.4% (92/109). 2D-TVUS demonstrated superior accuracy and consistency (88.07%, Kappa = 0.612) compared with TAS (84.4%, Kappa = 0.493). The combined modality achieved the best performance across all metrics (Sen 93.48%, Spe 88.24%, Acc 92.66%), which was significantly better than either modality alone. CONCLUSIONS: The combined use of 2D-TVUS and TAS can enhance the diagnostic efficacy for EP and may offer complementary diagnostic value in specific clinical settings. However, its routine application requires validation through prospective multicenter studies.