Comparison of Transvaginal Sonography and Saline Contrast Sonohysterography in Women

Muhammad Aslam, Lubna Ijaz, Shamsa Tariq, Kausar Shafqat, Meher-un Nisa, Rubina Ashraf, Tahira Kazmi

Abstract


Background: Transvaginal ultrasound is used conventionally as initial investigation of patients with abnormal uterine bleeding
but saline contrast sonohysterography is a better technique to reliably distinguish focal from diffuse endometrial lesions. This
study was performed to compare the ability of transvaginal ultrasonography and saline infusion sonohysterography as initial
modality for the diagnosis of endometrial abnormalities in women with abnormal uterine bleeding.
Patients and Methods: In a prospective study, 100 women with abnormal uterine bleeding were submitted to sequential
examination by transvaginal ultrasound, and sonohysterography. The presence of focal endometrial lesions and the type of
lesion (endometrial hyperplasia, polyp, submucous myoma, or malignancy) were noted. Predictive values were calculated by
correlating the results with final diagnosis reached by hysteroscopy and endometrial biopsy.
Results: The sonohysterography had 92.9% sensitivity and 89.7% specificity compared to 71.4% sensitivity and 67.7%
specificity achieved by transvaginal sonography. There was 91% agreement between saline contrast sonohysterography and
hysteroscopy as compared to 69% for TVS (p = 0.002). The diagnostic performance of sonohysterography for 3 main
endometrial abnormalities (i.e. endometrial hyperplasia, polyps and submucous myoma) was better than transvaginal
sonography. The best results were seen in cases of submucous myoma where sensitivity and specificity of sonohysterography
reached to 100% as compared to TVS (61.55 and 97.7% respectively).
Conclusion: Our results have substantiated that sonohysterography is a better tool than transvaginal sonography for the
assessment of endometrial intra-cavity lesions. By providing accurate differentiation between focal and diffuse endometrial
lesions, it can help in decision making regarding selection of cases for hysteroscopy and directed biopsy. We recommend that
saline contrast sonohysterography should be used as an initial investigation in cases of abnormal uterine bleeding.
Keywords: Ultrasound, transvaginal sonography, sonohysterography, hysteroscopy, abnormal uterine bleeding.

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