What is the appropriate diagnostic evaluation of fibroids?
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Although transvaginal sonography (TVS) has inconsistent sensitivity (0.21-1.00) and specificity (0.53-1.00), its cost-efficiency and noninvasiveness make it the best initial test for ruling in fibroid disease (strength of recommendation [SOR]: B, based on expert opinion, a systematic review, and prospective studies). Sonohysterography (SHG) and hysteroscopy have superior sensitivity, specificity, and more discriminating positive and negative likelihood ratios for diagnosing fibroids than does TVS (SOR: B, systematic review). SHG is less painful, less invasive, and more cost-effective than hysteroscopy (SOR: B; single, prospective comparative study and cost comparison). Magnetic resonance imaging (MRI) had comparable precision to TVS in a single study, but it is too expensive to be a good initial test for fibroids (SOR: C, expert opinion and an uncontrolled prospective study). One study reported a strong correlation between ultrasound and bimanual examination (SOR: C, retrospective case review).
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