NASHVILLE — A point-of-care ultrasound device performed comparable to diagnostic imaging read by ob/gyn sonographers in identifying gynecologic pathology, and could have applicability in low-resource settings, a researcher said here.
A gynecologist-performed and interpreted point-of-care ultrasound for gynecologic anatomy and pathology had comparable accuracy to reference imaging and high levels of agreement of clinical diagnosis, and was feasible and acceptable to patients in a low-resource setting, reported Marika Toscano, MD, of the University of Rochester Medical Center in New York.
Toscano said that no prior studies have examined gynecologist-performed and interpreted point-of-care ultrasound in low resource international settings, in a presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting,
They performed their study in three parts. The first part compared three handheld point-of-care ultrasound devices and selected one. This was done on 20 participants in the U.S., about two-thirds of whom were Caucasian, and had a BMI of 29; 80% were premenopausal.
Each participant underwent a scan with a handheld device performed at the bedside by a clinician. Devices were stripped of identifying information and then compared by two sonographers to reference images using a 5-point Likert scale to score image quality.
The Philips Lumify ultrasound device was selected for its lower overall cost and longer continuous scan time, Toscano said. The second part of the study validated the device in further testing. This compared measurements of ovarian pathology of 40 participants from the point-of-care ultrasound to reference images from sonographers.
Toscano’s group then examined the agreement between a bedside diagnosis from the point-of-care ultrasound to the reference images including:
- Endometrial pathology
- Right ovary
- Left ovary
- Adnexal pathology present
Toscano said overall, the point-of-care ultrasound showed “high levels of concordance” for all variables, except for the left and right ovary, “which were difficult to image with a handheld device,” she said. However, she noted “good sensitivity” for endometrial pathology and fibroids with the handheld device.
The third part of the trial was the pilot test in Borgne, Haiti. This was a region that was only accessible by footpaths, had been assessed to have a need for basic gynecologic care, and did not have imaging and ultrasound services in the region, Toscano said.
The 20 patients in the third part of the study had a mean age of 38, were mostly parous, were all of African descent, and were mostly lacking in education and employment.
Fortunately — or perhaps unfortunately — Toscano’s group found “mostly normal anatomy” in these patients — only one fibroid and one simple ovarian cyst and no clinically significant pathology. As a result, no participants could be triaged for referral based on these findings, Toscano said.
Susan Khalil, MD, of Icahn School of Medicine at Mount Sinai in New York City, noted that this was a small study, but thought the idea showed promise.
“The implications of this study are promising in combination with telemedicine or in the proper hands, especially in resource limited settings,” Khalil, who was not involved in the study, told MedPage Today. “Further studies would be needed, however, this is important for trying to improve diagnostic accuracy.”
The study was supported by the University of Rochester Medical Center’s OBGYN Department Pilot Research Grant. All imaging devices were either obtained on loan or by grant funding.
Toscano disclosed no relevant relationships with industry.