Table 3.

Study characteristics

			Patient group			Main results
Study	No. of patients	Study design	Inclusions	Exclusions	Indications for hysterectomy	Sensitive	Specific
Exacoustos et al.17	72	Prospective	Consecutive premenopausal scheduled for hysterectomy for benign pelvic pathology	Pregnant & postmenopausal patients, those on hormonal therapy, fibroids >8 cm, 3× fibroids >5 cm	Menorrhagia/abnormal uterine bleeding 76%, uterine prolapsed 10%, ovarian pathology 10%	Heterogenous myometrium 88%	Myometrial cysts 98%, linear striations 90%, asymmetrical myometrium 80%
Hak18	50	Prospective	Perimenopausal planned for hysterectomy for menorrhagia	Patients with chronic pain	Menorrhagia	Hypoechoic areas 83%, heterogenous areas 75%	Myometrial cysts, linear striations, globular uterine configuration all 100%, hypoechoic areas 95%, heterogenous areas 87%
ElKattan et al.19	352	Prospective	All patients scheduled for hysterectomy.? consecutive	Patients who refused hysterectomy or were unfit for surgery.	Leiomyoma 42%, abnormal uterine bleeding 31%, endometrial hyperplasia 9%, prolapse 8%, adnexal masses 8%, cervical masses 1%.	Heterogenous myometrial echo texture 95%, poor endomyometrial delineation 76%, myometrial cysts 70%	Linear myometrial striations 91%
Sun et al.11	213	Retro-spective	Consecutive patients scheduled for hysterectomy	None	Dysmenorrhoea, menometrorrhagia, cervical masses, adnexal masses, prolapsed, endometrial hyperplasia or carcinoma	Linear myometrial striations 92%, heterogenous myometrium 87%, myometrial cysts 82%.	Globular uterine configuration 78%, myometrial A-P asymmetry 75%
Kepkep et al.10	70	Prospective	Consecutive patients scheduled for hysterectomy	None	Leiomyoma 40%, endometrial hyperplasia 25%, adnexal tumours 11%, abnormal uterine bleeding 11%, prolapsed 6%, cervical dysplasia 3%, postmenopausal bleeding 3%	Heterogenous myometrium 81%	Linear myometrial striations 96%, globular configuration 86%, poor delineation of endomyometrial junction 82%, myometrial cysts 82%
Bazot et al.20	129 Group 1 23 Group 2 106	Prospective	? consecutive patients scheduled for hysterectomy Group 1 – with menometrorrhagia but free of myoma & endometrial disorders on TAS Group 2 – all other	None	Menorrhagia and/or metrorrhagia 71%, endometrial carcinoma 10%, cervical masses 6%, adnexal masses 8%, prolapse 10%	Group 1: heterogenous myometrial echo texture 100%, myometrial cysts 81% Group 2: Globular uterine configuration 92%, heterogenous myometrial echo texture 88%	Group 1: Myometrial cysts, linear myometrial striations, asymmetric myometrium, globular configuration all 100% Group 2: Linear myometrial striations 99%, myometrial cysts 98%, globular uterine configuration 96%, asymmetric myometrium 83%.
Bazot et al.12	120	Prospective	? consecutive patients referred for hysterectomy	47 excluded – lack of US/MRI findings 55% cancelled surgery, conservative surgery, endometrial resection	Menorrhagia and/or metrorrhagia 45%, postmenopausal bleeding 13%, adnexal masses 11%, cervical masses 9%, pelvic pain 12%, prolapsed 8%, miscellaneous 2%	Myometrial cyst 60%	Myometrial cyst 99%, globular uterine configuration 96%, heterogenous myometrial echo texture 90%
Atri et al.21	102	Prospective	Intact hysterectomy specimens (pre- and postmenopausal)	Substantial distortion due to leiomyomas	Uterine prolapse 14%, incontinence 7%, premenopausal uterine bleeding & dysmenorrhoea 31%, pelvic pain 5%, postmenopausal bleeding 3%, suspicious endometrial biopsy 16%, adnexal mass 19%, transexuality 2%, familial ovarian cancer 3%.	Hypoechoic myometrium (OR) 24.5, asymmetric myometrium (OR) 10.7	Heterogenous myometrium (OR) 1.8
Botsis et al.22	194	Prospective	Enlarged uterus on TVS	Uterine nodules <2 cm	Menorrhagia and/or dysmenorrhoea 83%, pressure/pain consistent with a mass lesion 2%, dyspareunia 10%, urinary incontinence 3%, rapid tumour growth 1%	Irregular enlarged uterus 100%

Studies included in meta-analysis