***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The MUSA ( Morphological Uterus Sonographic Assessment ) statement is a consensus statement on terms , definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography , color/power Doppler and three-dimensional ultrasound imaging . The terms and definitions described may form the basis for prospect i ve studies to predict the risk of different myometrial pathologies , based on their ultrasound appearance , and thus should be relevant for the clinician in daily practice and for clinical research . The sonographic features and use of terminology for describing the two most common myometrial lesions ( fibroids and adenomyosis ) and uterine smooth muscle tumors are presented OBJECTIVE To compare gel instillation sonohysterography ( GIS ) with saline contrast sonohysterography ( SCSH ) as diagnostic methods for the evaluation of the uterine cavity . METHODS A prospect i ve cohort study was performed at the Department of Obstetrics and Gynecology of the VU University Medical Center , Amsterdam , between September 2007 and April 2008 . We included 65 women suspected of having an intrauterine abnormality with an indication for SCSH/GIS .  First SCSH and subsequently GIS were performed in all women .  Distension of the uterine cavity , image quality , visualization of intrauterine abnormalities and pain experienced on a visual analog scale ( VAS score ) were recorded for both procedures . RESULTS The mean distension with GIS was 9.0 mm and with SCSH it was 8.5 mm ( P = 0.15 ) . The mean image quality , on a scale from 0 to 5 , for SCSH was 4.0 and for GIS it was 3.6 ( P = 0.01 ) . No difference was found for the visualization of intrauterine abnormalities , and the VAS scores for pain experienced on SCSH and GIS were 1.5 and 1.6 , respectively ( P = 0.62 ) . CONCLUSIONS The image quality of SCSH is slightly better than that of GIS . This difference is likely to be attributable to the presence of air bubbles in the gel . The small difference in uterine cavity distension in favor of GIS and comparable stable distension during at least 4 min make GIS a suitable alternative for SCSH if air bubbles can be prevented OBJECTIVE To demonstrate the diagnostic efficacy of 2D B-mode , color and pulsed Doppler Hy-Co-Sy and 3D B-mode and power Doppler Hy-Co-Sy . STUDY DESIGN AND METHODS One hundred and fifty-two women were recruited into the 2D B-mode , color and pulsed Doppler Hy-Co-Sy study and 116 other women were recruited into the 3D B-mode and power Doppler Hy-Co-Sy study .  We assessed the diagnostic performance ( sensitivity , specificity , PPV and NPV ) of 2D and 3D Hy-Co-Sy , compared to hysteroscopy , and laparoscopy and dye test in the assessment of uterine abnormalities and tubal patency , respectively . RESULTS The sensitivity , specificity , PPV and NPV of 2D hysterosonography compared to hysteroscopy were 93.6 , 97.3 , 98.2 and 97.3 % , respectively . The sensitivity , specificity , PPV and NPV of 3D hysterosonography  compared to hysteroscopy were 97.9 , 100 , 97.9 and 100 % , respectively . Addition of color and pulsed Doppler to 2D Hy-Co-Sy and power Doppler to 3D Hy-Co-Sy contributed to diagnostic precision in detection of tubal patency . The sensitivity , specificity , PPV and NPV of 3D power Doppler Hy-Co-Sy in detection of tubal patency compared to laparoscopy and dye intubation were 100 , 99.1 , 99.2 and 100 % , respectively . CONCLUSION 2D and 3D Hy-Co-Sy are accurate methods for evaluation of uterine abnormalities and tubal patency in infertile patients Objective : To examine the results of transcervical resection of submucous fibroids in relation to the degree of intramural extension . Methods : A prospect i ve 3-year observational study was performed of transcervical resection of submucous fibroids for abnormal uterine bleeding .  The mean follow-up was 20 months ( range 10 - 34 ) . Fifty-one patients with a mean age of 38 years ( range 23 - 55 ) were treated with transcervical resection after classification according to the degree of intramural extension of the submucous fibroids . The intention was to perform complete resection , established at control hysteroscopy . A repeat procedure was performed in cases of incomplete resection unless the patient denied further hysteroscopic treatment . Outcome measures were control of bleeding , subsequent surgery , number of procedures , number of complete resections , and number of recurrences . Results : Bleeding was controlled in 48 ( 94.1 % ) of all patients after final resection . Hysterectomy was performed in three patients ( 5.9 % ) because of persistent complaints : in two cases after incomplete resection and in one case after complete resection . Three patients were lost to follow-up . Of the remaining 45 patients ( 42 with complete and three with incomplete final resection ) , three ( 6.7 % ) had a recurrence ( one after complete and two after incomplete final resection ) . With more extensive intramural involvement , the chance to achieve complete resection decreased and the mean number of procedures to achieve complete resection increased . Conclusions : Complete resection improves the long-term results of transcervical resection of submucous fibroids for control of abnormal uterine bleeding .  Transcervical resection of submucous fibroids with more than 50 % intramural extension should be performed only in selected cases , as complete resection usually necessitates repeat procedures In a community survey  521 women aged 35 - 59 were selected at r and om from all patients registered in two groups practice s. They were interviewed at home and assessed by means of st and ardised psychiatric measures and detailed gynaecological inquiry . Levels of psychiatric morbidity were found to be within the expected range for such a sample . Both psychiatric morbidity and the personality dimension of neuroticism were significantly associated with gynaecological symptoms , including dysmenorrhoea and premenstrual tension , some symptoms of excessive menstruation , and flushes and sweats but not disappearance of menstruation for over six months . Current psychiatric state was significantly associated with recent adverse life events and with indices of psychiatric vulnerability ( neuroticism and previous psychiatric history ) , suggesting possible aetiological links with gynaecological symptoms . The findings of this study have implication s for the management of gynaecological complaints in general practice BACKGROUND The purpose of this study was to compare three-dimensional saline infusion sonohysterography ( 3D SIS ) and diagnostic hysteroscopy for the diagnosis and classification of submucous uterine fibroids . METHODS This was a prospect i ve double-blind study of 49 women who presented with a history of menorrhagia , diagnosed on non-enhanced two-dimensional ultrasonography with submucous fibroids .  Fibroids were classified on 3D SIS according to the proportion of fibroid contained within the endometrial cavity , using the European Society of Hysteroscopy Classification of Submucous Fibroids . These results were then compared with the findings at diagnostic hysteroscopy . RESULTS A total of 61 submucous fibroids was identified in 49 symptomatic women . Diagnostic hysteroscopy confirmed these findings in all cases . There was agreement between the two methods in 11/12 cases of Type 0 fibroids ( 92 % ) , 34/37 ( 92 % ) of Type I fibroids and 9/12 ( 75 % ) of Type II fibroids . The overall level of agreement was good with a kappa value of 0.80 . CONCLUSIONS There is a good overall agreement between 3D SIS  and diagnostic hysteroscopy in classification of submucous fibroids . Agreement is better in cases where a greater proportion of the fibroid is contained within the uterine cavity This study was conducted to assess whether women would prefer to undergo  saline infusion sonography ( SIS ) or office hysteroscopy  for the investigation of the uterine cavity . In a r and omised controlled trial , 100 patients underwent SIS or office hysteroscopy for assessing patients ' pain scores . After the investigation , 92 of them were asked to fill out an anonymous question naire addressing their preference regarding the method of evaluation and treatment of the uterine cavity . A control group , consisting of 50 women who never underwent SIS or office hysteroscopy  , was also asked to complete an identical question naire . The question naire was completed by 113 women ( 83.7 % ) . Twenty-four ( 21.2 % ) women would opt for SIS , whereas 52 ( 46.0 % ) would opt for office  hysteroscopy  , and 37 ( 32.7 % ) had no preference . If therapy would be necessary , 48.7 % of the women would opt for an outpatient treatment , whereas 33.0 % of the women would prefer treatment under general anaesthesia . Despite the fact that SIS is less painful , the majority of the women prefer office hysteroscopy .  Additionally , therapy in an outpatient setting is preferred to a day case setting OBJECTIVE To measure the accuracy of three-dimensional ( 3D ) sonohysterography in detecting intrauterine lesions . DESIGN Prospect i ve study . SETTING Teaching hospital . PATIENT(S ) Two hundred nine infertile patients suspected to have an intrauterine lesion on 2D ultrasound or hysterosalpingography .  INTERVENTION(S ) Three-dimensional ultrasound , 2D and 3D sonohysterography ( SHG ) .  Ninety-two of the patients had a lesion distorting the endometrium on the 3D SHG , and those were referred for hysteroscopy . MAIN OUTCOME MEASURE(S ) Sensitivity and specificity of 2D , 3D ultrasound , and 2D SHG compared to 3D SHG . RESULT ( S ) Of the 92 patients with a lesion , 48 had polyps , 35 submucous/intramural myomas , 3 both polyps and myomas , 4 müllerian anomalies , 1 thick endometrium , and 1 synechiae . Compared with the 3D SHG results , the sensitivity and specificity were 97 % and 11 % for the 2D transvaginal ultrasound , 87 % and 45 % for the 3D ultrasound , and 98 % and 100 % for the 2D SHG . In the group of 59 patients who had hysteroscopy , the sensitivity of the 2D SHG and 3D SHG were 98 % and 100 % , with a positive predictive value of 95 % and 92 % , respectively . CONCLUSION ( S ) Three-dimensional sonohysterography allows precise recognition and localization of lesions . If 2D and 3D SHG are normal , invasive diagnostic procedures such as hysteroscopy could be avoided Diagnosis is a critical component of health care , and clinicians , policymakers , and patients routinely face a range of questions regarding diagnostic tests . They want to know whether testing improves outcome ; what test to use , purchase , or recommend in practice guidelines ; and how to interpret test results . Well- design ed  diagnostic test accuracy studies can help in making these decisions , provided that they transparently and fully report their participants , tests , methods , and results as facilitated , for example , by the STARD ( St and ards for Reporting of Diagnostic Accuracy ) statement ( 1 ) . That 25-item checklist was published in many journals and is now adopted by more than 200 scientific journals worldwide . As in other areas of science , systematic review s and meta- analysis of accuracy studies can be used to obtain more precise estimates when small studies addressing the same test and patients in the same setting are available . Review s can also be useful to establish whether and how scientific findings vary by particular subgroups , and may provide summary estimates with a stronger generalizability than estimates from a single study . Systematic review s may help identify the risk for bias that may be present in the original studies and can be used to address questions that were not directly considered in the primary studies , such as comparisons between tests . The Cochrane Collaboration is the largest international organization preparing , maintaining , and promoting systematic review s to help people make well-informed decisions about health care ( 2 ) . The Collaboration decided in 2003 to make preparations for including systematic review s of diagnostic test accuracy in their Cochrane Data base of Systematic Review s. To enable this , a working group ( Appendix ) . was formed to develop methodology , software , and a h and book The first diagnostic test accuracy review was published in the Cochrane Data base in October 2008 . In this paper , we review recent method ological developments concerning problem formulation , location of literature , quality assessment , and meta- analysis of diagnostic accuracy studies by using our experience from the work on the Cochrane H and book . The information presented here is based on the recent literature and up date s previously published guidelines by Irwig and colleagues ( 3 ) . Definition of the Objectives of the Review Diagnostic test accuracy refers to the ability of a test to distinguish between patients with disease ( or more generally , a specified target condition ) and those without . In a study of test accuracy , the results of the test under evaluation , the index test , are compared with those of the reference st and ard determined in the same patients . The reference st and ard is an agreed-on and accurate method for identifying patients who have the target condition . Test results are typically categorized as positive or negative for the target condition . By using such binary test outcomes , the accuracy is most often expressed as the test ' 
    Output:
    
Low- quality evidence suggests that 3D SIS may be very accurate in detecting intracavitary abnormalities .
Meta- analysis revealed no statistically significant differences between 2D SIS and 3D SIS .
Summary sensitivity and summary specificity are higher for 3D SIS , but margins of improvement are limited because 2D SIS is already very accurate .
When the technology and appropriate expertise are available , 3D SIS offers an alternative to 2D SIS .