DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20170405

Diagnostic accuracy of saline infusion sonography as compared to hysteroscopy in premenopausal women with abnormal uterine bleeding

Manoj Kumar Tangri, Ajay Krishna Srivastava

Abstract


Background: In patients with abnormal uterine bleeding (AUB), differentiating whether the cause is anovulation or anatomic lesions can be challenging. Transvaginal sonography (TVS) has limitation in form of high false negative rate for diagnosing focal intrauterine pathology. To improve the image in TVS, saline injected into uterine cavity can be used as a negative contrast agent. Aim of our study was to evaluate the clinical value of saline infusion sonography (SIS) by comparing its diagnostic accuracy with that of established gold standard i.e. hysteroscopy.

Methods: The study was carried out in a referral and teaching public sector hospital in eastern India from July 2015 to June 2016. Study population consisted of 136 premenopausal women with AUB, who were scheduled to undergo diagnostic hysteroscopy. Patients were first evaluated by sis and then followed by hysteroscopy on a later date.

Results: Both SIS and hysteroscopy could be successfully performed in 136 out of 144 patients. When all findings by SIS (any pathological findings in uterine cavity vs. none) were combined and compared with hysteroscopy (gold standard), both sensitivity and specificity of sis were 0.88 whereas PPV and NPV were 0.85 and 0.90 respectively.

Conclusions: Because of comparable results obtained by evaluating patients by SIS as well as office hysteroscopy, we recommend saline infusion sonography as a valuable tool for evaluating premenopausal women with abnormal uterine bleeding, before consideration for hysteroscopy.


Keywords


AUB, Hysteroscopy, NPV, PPV, SIS, TVS

Full Text:

PDF

References


William CD, Paul B. Marshburn. A prospective study of transvaginal hydrosonography in the evaluation abnormal uterine bleeding. Am J Obstet Gynecol. 1998;179:292-8.

Chambers J, Chambers S. Endometrial sampling: when? Where? Why? With what? Clin Obstet Gynaecol. 1992;35:28-39.

Dubinsky TJ, Parvey HR, Gormaz G. Transvaginal hysterosonography: Comparison with biopsy in the evaluation of postmenopausal bleeding. J Ultrasound Med. 1995;14:887-93.

Guido RS, Kanbour Shakir A, Rulin MC. Pipelle endometrial sampling: Sensitivity in the detection of endometrial lesions. Cancer Journal of Reproductive Medicine. 1995;40:553-5.

Angioni S, Loddo A, Milano F. Detection of intra-cavitary lesion in postmenopausal women with abnormal uterine bleeding:a prospective comparative study on outpatient hysteroscopy and blind biopsy. J Minim Invasive Gynecol. 2008;15:87-91.

Granberg S, Wikland M, Karlsson B. Endometrial thickness as measured by endovaginal ultrasonography for identifying endometrial abnormality. Am J Obstet Gynecol. 1991;64:47-52.

Debra L, Berridge, Thomas C. Saline infusion sonohysterography technique, indications, and imaging ļ¬ndings. J Ultrasound Med. 2004;23:97-112.

Parson AK, Lense H. Sonohysterography for endometrial abnormalities: preliminary results. J Clin Ultrasound. 1993;21:87-95.

Indman PD. Abnormal uterine bleeding: Accuracy of vaginal probe ultrasound in predicting abnormal hysteroscopic findings. J Reprod Med. 1995;40:545-8.

Finikiotis G. Hysteroscopy an analysis of 523 patients. Aust Nz J Obst Gyn. 1989;29:253-8.

Widrich T, Bradley LD, Mitchinson A. Comparison of saline infusion sonography with office hysteroscopy for the evaluation of the endometrium. Am J Obstet Gynecol. 1996;174:1327-34.

Towbin NA, Gviazda IM, March CM. Office hysteroscopy versus transvaginal sonography in the evaluation of patients with excessive uterine bleeding. Am J Obstet Gynecol. 1996;174:1678-82.

Rudra S, Duggal BS, Bharadwaj D. Prospective study of saline infusion sonography and office hysteroscopy. Med J Armed Forces India. 2009;65:332-5.

Cicinelli E, Romano F, Anastasio P. Transabdominal sonohysterography, transvaginal sonography, and hysteroscopy in the evaluation of submucous myomas. Obstet Gynecol. 1995; 85:42-7.

Wolman I, Jaffa AJ, Hartoov J, Amiram BA, David MP. Sensitivity and specificity of sonohysterography for the evaluation of the uterine cavity in perimenopausal patients. J Ultrasound Med. 1996;15:285-8.

de Kroon CD, de Bock GH. Saline contrast hysterosonography in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG: an International Journal of Obstetrics and Gynaecology. 2003;110:938-47.

Chawla I, Tripathi S, Vohra P, Singh P. To evaluate the accuracy of Saline Infusion Sonohysterography (SIS) for Evaluation of Uterine Cavity Abnormalities in Patients with Abnormal Uterine Bleeding. The Journal of Obstetrics and Gynecology of India. 2014;64(3):197-201.

Sowjanya N, Pallavee P. Comparative study of saline infusion sonography and hysteroscopy for evaluation of uterine cavity in abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2015;4(3):828-32.

William CD, Paul B. A prospective study of transvaginal hydrosonography in the evaluation abnormal uterine bleeding. Am J Obstet Gynecol. 1998;179:292-8.

Goldstein SR, Zeltser I, Horan CK. Ultrasonography based triage for perimenopausal patients with abnormal uterine bleeding. Am J Obstet Gynecol. 1997;177:102-8.