Publications of Faculty of Medicine:COMPARATIVE STUDY OF TRANS VAGINAL ULTRASONOGRAPHY AND SALINE INFUSION SONOHYSTEROGRAPHY IN EVALUATION OF ENDOMETRIAL AND SUBENDOMETRIAL ABNORMALITIES IN PATIENTS WITH ABNORMAL UTERINE BLEEDING: Abstract

Objectives: To determine the superadded diagnostic value of saline infusion sonohysterography (SIS) over the transvaginal ultrasonography (TVS) in detecting endometrial and subendometrial lesions determined by direct visualization of the intrauterine cavity with hysteroscopy. Patients and Methods: Between October 2002 through august 2004, 58 patients with persistent abnormal uterine bleeding despite at least 3 months of medical treatment were referred for TVS, SIS as well as hysteroscopy and biopsy. Results: twenty three patients were confirmed to have intracavitary uterine abnormality. SIS was able to identify all patients with endometrial and subendometrial abnormalities in comparison to TVS which identified only 15 patients, and SIS was able to identify 31 of the 35 patients reported normally by hysteroscopy in comparison to 32 patients by TVS. SIS yielded a sensitivity of 100%, a specificity of 88.6%, a positive predictive value of 85.2%, and a negative predictive value (NPV) of 100%. Whereas TVS yielded a sensitivity of 65.2%, a specificity of 91.4%, a positive predictive value of 83.3%, and a negative predictive value of 800.4. Conclusion: SIS is simple non-invasive inexpensive procedure that yields additional information over TVS. It allows reliable differentiation between focal and diffuse endometrial and subendometrial lesions. It has equal sensitivity and NPV as hysteroscope and offers substantial advantages over hysteroscopy in terms of time, cost, patient comfort, availability, and risk. Its use could be implemented as a standard test in patients 14 with abnormal uterine bleeding regardless of the results of the transvaginal ultrasonography and before the consideration of hysteroscopy