Comparison of transvaginal sonography, saline infusion sonography and hysteroscopy in the evaluation of uterine cavity pathologies

Aims:  To determine whether performing transvaginal sonography (TVS) and saline infusion sonography (SIS) before hysteroscopy could reduce the number of diagnostic hysteroscopies performed for the evaluation of uterine cavity abnormalities. Methods:  Two hundred and twenty three women with suspected...

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Published in:Australian & New Zealand journal of obstetrics & gynaecology 2005-02, Vol.45 (1), p.30-35
Main Authors: CEPNI, Ismail, OCAL, Pelin, ERKAN, Sanli, SARICALI, Funda Salihoglu, AKBAS, Hande, DEMIRKIRAN, Fuat, IDIL, Mehmet, BESE, Tugan
Format: Article
Language:English
Subjects:
endometrial polyp
Female
Humans
Hysteroscopy
Leiomyoma - diagnosis
Polyps - diagnosis
Prospective Studies
saline infusion sonography
Sensitivity and Specificity
Sodium Chloride
submucous fibroid
transvaginal sonography
Ultrasonography
Uterine Diseases - diagnosis
Uterine Neoplasms - diagnosis
Vagina - diagnostic imaging
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Summary:Aims:  To determine whether performing transvaginal sonography (TVS) and saline infusion sonography (SIS) before hysteroscopy could reduce the number of diagnostic hysteroscopies performed for the evaluation of uterine cavity abnormalities. Methods:  Two hundred and twenty three women with suspected uterine cavity abnormalities were prospectively evaluated by TVS, SIS and hysteroscopy, and had histological evaluation of the endometrium with hysteroscopic biopsy or dilatation and curettage (D&C). One hundred and sixty five patients (74%) were premenopausal and 58 patients (26%) were postmenopausal. Results:  The positive predictive value (PPV) for endometrial polyps was 69% for TVS, 78% for SIS and 81% for hysteroscopy in premenopausal patients. In the postmenopausal group, TVS and SIS could detect only 24% of endometrial polyps, whereas 70% were diagnosed by hysteroscopy. The PPV for submucous fibroids was 47% for TVS, 81% for SIS and 77% for hysteroscopy in the premenopausal group. Conclusions:  In premenopausal patients, SIS and hysteroscopy are equally accurate in the diagnosis of endometrial polyps and submucous fibroids. Hysteroscopy is the most accurate test for polypoid lesions in the postmenopausal group. Performing TVS, SIS and D&C could reduce the number of diagnostic hysteroscopies performed for the evaluation of uterine cavity abnormalities by 71.5% in premenopausal patients. However, this rate decreases to 40% in the postmenopausal group.
ISSN:0004-8666
1479-828X
DOI:10.1111/j.1479-828X.2005.00336.x