Diagnostic Accuracy of Transvaginal Sonography, Sonohysterography and Office Hysteroscopy in the Evaluation of Abnormal Uterine Bleeding

  • Ümit Göktolga
  • Mutlu Ercan
  • Müfit Cemal Yenen
  • Seyit Temel Ceyhan
  • Ugur Keskin
  • Iskender Baser

Turk J Obstet Gynecol 2007;4(2):137-143

OBJECTIVE: To find out the diagnostic accuracy of transvaginal sonography (TVS) and saline infusion sonography (SIS) by comparing the results with hysteroscopy (HSC) and hystological reports obtained by endometrial biopsies in pre and postmenopausal women with abnormal uterine bleeding (AUB). Design: Prospective study Setting: women presenting with abnormal uterine bleeeding as an outpatient procedure, in Gülhane Military Medical Faculty, between June 01, 2004 – August 01, 2005. Patients: 38 premenopausal and 6 postmenopausal patients Interventions: TVS and SIS was performed at the same seance and they underwent hysteroscopy and hysteroscopic biopsy one week later. Main outcome measures: The findings at TVS and SIS were compared with the hysteroscopic views and histologic findings. The sensitivity and spesifity ratios of all three methods were calculated in defining the endometrial and intracavitary pathologies. RESULTS: The sensitivity ratios of TVS and SIS in defining endometrial pathologies was 36.4% and 33.8% respectively and the sensitivity of hysteroscopy was lower. (%28.6, p=0.24) In the comparison of spesifity ratios sonohysterography had a higher ratio than others. (TVS vs SIS, p=0.08; HSC vs SIS, p=0.07) As a result; in outpatient group, hysteroscopy gives not much more information than SIS. The detection rate of focal intrauterine pathology (polyp/submucous myoma) using conventional TVS was significantly lower than sonohysterography. (sensitivity ratios; 46.5% and 97.1% respectively; p=0.0009) The sensitivity ratios of hysteroscopy (100%) and SIS (97.1) was similar. (p=0.98) CONCLUSIONS: Sonohysterography is a current, trustable method which can replace office hysteroscopy in the diagnosis and evaluation of cases presenting with AUB especially in outpatient group.

Keywords: Abnormal uterine bleeding, transvaginal sonography, saline infusion sonography, hysteroscopy.