Abstract Archives of the RSNA, 2013
Wendaline Marie McEachern MD, Presenter: Nothing to Disclose
Ian Suchet, Abstract Co-Author: Nothing to Disclose
John Thiel, Abstract Co-Author: Consultant, Conceptus, Inc
We hypothesize that the shape of the Essure microinsert on ultrasound is able to predict complications evident on hysterosalpigogram (HSG), the accepted gold standard.
From July 2, 2009 to July 2, 2012, 441 women at our institution received Essure microinsert placement for the purpose of permanent sterilization. 2D, 3D and 4D volume contrast imaging-coronal plane (VCI-C) transvaginal ultrasounds were performed three months after Essure microinsert placement. Those patients with complications identified on ultrasound, a non-diagnostic ultrasound or complications from the insertion procedure were referred for HSG. Patients with both HSG and ultrasound performed were retrospectively selected and anonymized. The ultrasounds were prospectively reviewed using previously archived 3D and 4D US volumes by a single, blinded radiologist. The shape of each Essure microinsert was described using a numeric grading system. This numeric descriptor was then recorded and compared to the previously reported HSG result.
The sensitivity of Essure microinsert shape on ultrasound in predicting complications, compared with standard HSG, was 94%, with a positive predictive value of 85%; specificity was 95%, with a negative predictive value of 98%.
Abnormal microinsert morphology is an excellent predictor of abnormality (sensitivity 94%). The positive predictive value of 85% results in slightly more individuals classified as “abnormal”, but is safer for patients as it leads to appropriate referral for HSG and recommendation for interim secondary form of contraception.
Ultrasound as a frontline modality for Essure microinsert assessment may contribute to a future FDA label change which mandates HSG post-insertion.
Pearls and Pitfalls of Essure Microinsert Imaging: Does Abnormal Shape on U/S Predict Complications on HSG?. Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13011242.html