{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T20:53:57Z","timestamp":1790456037790,"version":"4.1.0"},"reference-count":25,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T00:00:00Z","timestamp":1677196800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>National Institute for Health and Care Excellence Guideline 88 advocates outpatient hysteroscopy in preference to transvaginal ultrasound for premenopausal women with heavy menstrual bleeding, who are suspected of having submucosal fibroids, polyps or endometrial pathology. The guideline, however, analysed outdated studies that provided low-quality evidence. This study aimed to assess the diagnostic accuracy of transvaginal ultrasound in detecting endometrial pathology; and to evaluate the cost-effectiveness of outpatient hysteroscopy if it were to be used in preference to transvaginal ultrasound.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A health service evaluation was conducted at a district general foundation trust between 1 January 2019 and 31 March 2019 of all premenopausal women with heavy menstrual bleeding. A cost-effectiveness analysis was also performed to evaluate the financial implication of outpatient hysteroscopy being used in preference to transvaginal ultrasound.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>100 patients were included in the study. For the detection of endometrial pathology, transvaginal ultrasound had a positive predictive value of 65.2%; negative predictive value of 98.5%; sensitivity of 93.75%; specificity of 88.89% and an accuracy of 89.77%. For identifying endometrial polyps, submucosal fibroids and endometrial thickening, transvaginal ultrasound had a positive predictive value of 33.3%, 85.7% and 50%, respectively. It would have cost the Trust 78.7% more if National Institute for Health and Care Excellence\u2019s recommendation was carried out, with a 23.4% increase in workload in the hysteroscopy department, and a decrease of 7.8% transvaginal scans performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Outpatient hysteroscopy is costly and would increase the workload burden in the hysteroscopy department. Transvaginal ultrasound has a high sensitivity, specificity and accuracy in detecting endometrial pathology therefore it should remain as the initial diagnostic investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1742271x221147731","type":"journal-article","created":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T07:58:16Z","timestamp":1677225496000},"page":"284-291","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Should outpatient hysteroscopy be used in preference to transvaginal ultrasound to identify endometrial pathology in premenopausal women with heavy menstrual bleeding? Revisiting NICE Guideline 88"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9995-4060","authenticated-orcid":false,"given":"Natasha Christy","family":"Litherland","sequence":"first","affiliation":[{"name":"University Hospitals Sussex NHS Foundation Trust, Chichester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Phillips","sequence":"additional","affiliation":[{"name":"University of the West of England, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,2,24]]},"reference":[{"key":"bibr1-1742271X221147731","unstructured":"National Institute for Health Care Excellence. Heavy menstrual bleeding: assessment and management. NICE guideline 88, https:\/\/www.nice.org.uk\/guidance\/ng88\/resources\/heavy-menstrual-bleeding-assessment-and-management-pdf-1837701412549 (2018, accessed 10 July 2021)."},{"key":"bibr2-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.1016\/S0049-3848(17)30072-5"},{"key":"bibr3-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.3109\/01443615.2012.750287"},{"key":"bibr4-1742271X221147731","unstructured":"National Guideline Alliance. Heavy menstrual bleeding (update). NICE guideline 88. Evidence reviews for diagnostic test accuracy in investigation for women presenting with heavy menstrual bleeding, https:\/\/www.nice.org.uk\/guidance\/ng88\/evidence\/a-diagnostic-test-accuracy-pdf-4782293101 (2018, accessed 10 July 2021)."},{"key":"bibr5-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2010.11.011"},{"key":"bibr6-1742271X221147731","unstructured":"Royal College of Gynaecologists. National Heavy Menstrual Bleeding Audit, second annual report. A national audit to assess patient outcomes and experiences of care for woman with heavy menstrual bleeding in England and Wales, https:\/\/www.hqip.org.uk\/wp-content\/uploads\/2018\/02\/heavy-menstrual-bleeding-audit-reports-from-2011-to-2014.pdf (2014, accessed 15 July 2021)."},{"key":"bibr7-1742271X221147731","volume":"22","author":"Ramshaw N","year":"2019","journal-title":"Case Rep Womens Health"},{"key":"bibr8-1742271X221147731","unstructured":"National Health Service. NHS payment system, https:\/\/www.england.nhs.uk\/pay-syst\/ (2018, accessed 15 July 2021)."},{"key":"bibr9-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2016.09.010"},{"key":"bibr10-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.1016\/j.mjafi.2014.12.001"},{"key":"bibr11-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.1111\/jog.12937"},{"key":"bibr12-1742271X221147731","volume":"8","author":"Veena BT","year":"2014","journal-title":"J Clin Diagn Res"},{"key":"bibr13-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.2217\/whe.15.90"},{"key":"bibr14-1742271X221147731","first-page":"35","volume":"85","author":"Sweet MG","year":"2012","journal-title":"Am Fam Physician"},{"key":"bibr15-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12567"},{"key":"bibr16-1742271X221147731","first-page":"249","volume":"58","author":"Solja\u010di\u0107 Vrane\u0161 H","year":"2019","journal-title":"Acta Clin Croat"},{"key":"bibr17-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.5507\/bp.2018.010"},{"key":"bibr18-1742271X221147731","first-page":"627","volume":"58","author":"Solja\u010di\u0107 Vrane\u0161 H","year":"2019","journal-title":"Acta Clin Croat"},{"key":"bibr19-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2019.04.009"},{"key":"bibr20-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.1080\/13697137.2017.1358921"},{"key":"bibr21-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2013.09.016"},{"key":"bibr22-1742271X221147731","unstructured":"National Institute for Health Care Excellence. Social value judgements \u2013 principles for the development of NICE guidance 2nd ed, https:\/\/www.nice.org.uk\/Media\/Default\/about\/what-we-do\/research-and-development\/Social-Value-Judgements-principles-for-the-development-of-NICE-guidance.docx (2010, accessed 1 July 2021)."},{"key":"bibr23-1742271X221147731","unstructured":"National Institute for Health Care Excellence. Heavy menstrual bleeding \u2013 health economics, https:\/\/www.nice.org.uk\/guidance\/ng88\/evidence\/appendix-e-health-economics-pdf-4782293108 (2018, accessed 1 July 2021)."},{"key":"bibr24-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.3310\/hta18540"},{"key":"bibr25-1742271X221147731","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-13-491"}],"container-title":["Ultrasound"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1742271X221147731","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1742271X221147731","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1742271X221147731","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T07:51:08Z","timestamp":1777708268000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1742271X221147731"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,24]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1177\/1742271X221147731"],"URL":"https:\/\/doi.org\/10.1177\/1742271x221147731","relation":{},"ISSN":["1742-271X","1743-1344"],"issn-type":[{"value":"1742-271X","type":"print"},{"value":"1743-1344","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,24]]}}}