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DONALD F. RICHARDSON PRIZE PAPEREvaluating the Use of Handheld Point-Of-Care Ultrasound Testing for Gynecologic Pathology: A Pilot Study for Use in Low Resource Settings [07OP]

Toscano, Marika MD; Szlachetka, Kam RDMS; Whaley, Natalie MD, MPH; Thornburg, Loralei Lacina MD

Obstetrics & Gynecology: May 2019 - Volume 133 - Issue - p 5-6
doi: 10.1097/01.AOG.0000559083.62982.8f
Saturday, May 4, 2019

INTRODUCTION: Point of care ultrasound (POC-US) is clinician-performed ultrasound at the bedside with direct interpretation. POC-US allows increased access in low resource settings (LRS). We investigated whether POC-US can identify and triage gynecologic (GYN) pathology in a LRS.

METHODS: Validation of POCUS for GYN pathology performed in high resource setting as a prospective, blinded, cross-over study of 60 subjects. 20 subjects underwent POC-US with 3 test units (GE Vscan (US-V), Sonosite Iviz (US-I), Philips Lumify (US-L)) followed by reference diagnostic ultrasound (DxUS). Images scored blindly by two sonographers for quality and correlation; quantitative measurements compared. 40 subjects underwent POC-US with highest scoring device and reference DxUS. Concordance assessed by Cohen’s kappa and accuracy by Pearson’s and Bland-Altman plot. In a LRS, 20 subjects with GYN complaints underwent POC-US at a mobile clinic in North Haiti with intent to triage for referral.

RESULTS: US-V was inferior in image quality and correlation. US-L and US-I were equivalent; US-L selected for further validation. No statistically significant differences in US-L measurements of endometrium, uterus, ovaries, adnexal pathology, or leiomyomata (P<0.02 for all) with excellent concordance (Kappa >0.7 for pathology). Sensitivity/specificity of detecting pathology 80-100%. In a LRS, POC-US was acceptable to providers/patients and utilized successfully to visualize GYN structures. No subjects were triaged for referral based on POC-US.

CONCLUSION: Clinician-performed POC-US has high diagnostic accuracy, sensitivity/specificity for basic GYN anatomy and pathology. POC-US was an acceptable and feasible instrument in LRS, but future studies are needed to prove that POC-US improves GYN outcomes in LRS.

University of Rochester Medical Center, Rochester, NY

Financial Disclosure: Loralei Lacina Thornburg disclosed the following—board member of Perinatal Quality Foundation (no financial payments received). The other authors did not report any potential conflicts of interest.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.