Objective The aim of the study was to evaluate the diagnostic accuracy of 2-D saline infusion sonohysterography
(2-D SIS) and 3-D transvaginal ultrasound in comparison to diagnostic hysteroscopy (DHS) in the detection of
uterine abnormalities in infertile women with suspected uterine pathology by 2D ultrasound and
hysterosalpingiography (HSG).
Background Infertility may be caused by uterine lesions, such as fibroids, endometrial polyps, intrauterine
adhesions, or all of these. Natural conception may also be delayed by congenital uterine abnormalities. One out of
every six couples will experience infertility at some point in their lives.
Patients and methods
This was a comparative, interventional study which was conducted on 200 women attending Outpatient Clinic of
Benha University Hospital with suspected intrauterine abnormalities according to the history, clinical examination
and results of HSG to evaluate the diagnostic accuracy of 2D-SIS, 3D ultrasound compared to hysteroscopy in the
evaluation of uterine cavity from July 2018 to July 2021. All cases underwent 2D-SIS, 3D-TVS and DHS.
Results The study included 200 women in the age range of 20–39 years. All cases were divided into three groups.
Group I (72 cases) congenital uterine anomalies, group II (104 cases) filling defects (uterine fibroid and polypi)
and group III intrauterine adhesions. Taking DHS as the gold standard in diagnosis of all uterine abnormalities, the
Validity of 2D-SIS in prediction of group I in the form of sensitivity, specificity, positive predictive value (PPV),
negative predictive value (NPV) and diagnostic accuracy were 86.7%, 100%, 100%, 60% and 88.9% respectively
but the Validity of 3D-TVS were 100%, 66.7%, 93.8%, 100% and 94.4% respectively. In group II, the Validity of
2D-SIS in the form of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and
diagnostic accuracy were 100%, 83.3%, 95.2%, 100% and 96.2% respectively, but the Validity of 3D-TVS were
100%, 66.7%, 90.9%, 100% and 92.3% respectively. In group III, DHS was the best method for diagnosis of intra
uterine adhesions.
Conclusion Taking DHS as the gold standard in diagnosis of all uterine abnormalities, 3D-TVS had the best
accuracy in congenital uterine anomalies but 2D-SIS had the best accuracy in uterine fibroids and polypi. DHS
was the best method of diagnosis of intrauterine adhesions. |
