The diagnostic value of saline infusion sonohysterography in evaluation of patients with abnormal uterine bleeding

Cho, Hee Jung; Nam, Kye Hyun; Kim, Hee Tae; Kim, Jaeong Sik; Chung, Soo Ho; Lee, Kwon Hae; Lee, Jeong Jae

Abstract

OBJECTIVE
To evaluate saline infusion sonohysterography (SIS) as an investigative modality in abnormal uterine bleeding of premenopausal and postmenopausal women.
METHODS
Eighty eight patients, 74 premenopausal women and 14 postmenopausal women, with abnormal uterine bleeding were selected. After complete work-up, transvaginal examination were performed followed by SIS. The final surgical-pathologic findings were compared with the results obtained from transvaginal sonography (TVS) and SIS. The sensitivity, specificity, positive and negative predictive value were calculated for each procedure.
RESULTS
The SIS was perfomed in 85 cases. It couldn't be done in one premenopausal woman and two postmenopausal women. The uterine cavity was normal in 28 women, 57 cases displayed abnormalities. Seventeen had endometrial polyp, 17 had submucosal myoma, 23 had irregular endometrium. We found that SIS missed five endometrial polyp and mislabeled 14 (38.9%) false positive endometrial growth. On comparing SIS, transvaginal sonography missed nine endometrial polyp and mislabeled 22 (55%) false positive endometrial growth. The sensitivity, specificity, positive predictive value and negative predictive value of TVS were 72.9%, 45%, 61.4% and 58.1%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of SIS were 87.8%, 61.1%, 75.4% and 78.6%, respectively. Sensitivtity and negative predictive value were significantly higher with SIS than TVS.
CONCLUSION
The SIS is a safe, convenient, time conserving, cost effective, easily accessible and acceptable investigative modality. It definitely enhance the diagnostic potential of TVS in accessment of endometrium and intracavitary pathologies in women with abnormal uterine bleeding.