A comparison of outpatient hysteroscopy with saline infusion hysterosonography

Abstract

Objectives To establish the accuracy of saline infusion hysterosonography in diagnosing uterine pathology when compared with outpatient hysteroscopy. Design Prospective, parallel, blinded comparative study.Setting Outpatient hysteroscopy clinic in a large university teaching hospital.Population All women referred for outpatient hysteroscopy in a 15-month period.Interventions Women underwent saline infusion hysterosonography followed by flexible hysteroscopy. The ultrasonographer was blinded to the hysteroscopy result and the gynaecologist was blinded to the saline infusion hysterosonography result. Main outcome measures The relative success rates and pain scores for each procedure. The validity of saline infusion hysterosonography as a diagnostic test. Results One hundred and seventeen women entered the study; 70 women were premenopausal and 47 postmenopausal. In 27 women, one or both procedures could not be performed. Saline infusion hysterosonography failed in 20 women, on one occasion hysteroscopy failed and both investigations failed in six women. Ninety cases remained for direct comparison, with 78 cases of agreement on the uterine findings in both investigations. Twelve cases disagreed; in one case, an adhesion was seen, two cases with polyps and five with fibroids seen on ultrasound but not seen on hysteroscopy. There were four cases where polyps were identified on hysteroscopy but not on saline infusion hysterosonography. The median pain scores were 1.6 for saline infusion hysterosonography and 3.2 for hysteroscopy. Conclusions Both saline infusion hysterosonography and hysteroscopy are well tolerated by women. Saline infusion hysterosonography has a high failure rate but has a lower pain score than hysteroscopy.

Diagnostic accuracy of sonohysterography in the evaluation of uterine cavities in tamoxifen administered asymptomatic postmenopausal breast cancer patients with endometrial thickness ≥5 mm

“…They consequently concluded that HYS exposed the patients to the same pelvic discomfort as TV-SHG, but had a better feasibility rate [29]. Contrary to this, Rogerson et al reported that TV-SHG had a high failure rate but had a lower pain score than HYS [37]. We had a 6.7% unsuccessful TV-SHG rate and no failed HYS application.…”

Myomectomy: A review of surgical technique

“…HSG has the added advantage in allowing an assessment of tubal patency simultaneously. However hysteroscopy in several studies has been shown to be more accurate than sonohysterography or hysterosalpingography (Cicenelli, Romano, Anastasio, Blasi, Parisi, & Galantino, 1995;Rogerson, Bates, Weston, & Duffy, 2002;Schwarzler et al, 1998). Additionally it has the benefit that hysteroscopic resection can be performed at the same time.…”

Diagnostic strategies in endometrial cancer

“…SIS, in combination with an endometrium aspiration if necessary, can become the standard diagnostic procedure in women with abnormal uterine bleeding [15]. SIS is less painful, better tolerated by patients and less expensive than outpatient hysteroscopy [16][17][18]. The limitations of SIS include the cost (double TVS alone), the time to perform (an extra 5-10 min) and possible side effects, such as infection (very rare) and spilling of malignant cells [19].…”

“…All comparative studies concluded that SIS and hysteroscopy have similar accuracy in detecting endometrial lesions (polyps, fibroids and cancer) [16][17][18]29,30] but, in general, SIS is better tolerated by patients [16][17][18]. When assessing the cost-effectiveness of six strategies for the evaluation of menorrhagia (hormonal treatment; balloon ablation in all patients; TVS and therapeutic hysteroscopy; TVS, SIS and therapeutic hysteroscopy; SIS and therapeutic hysteroscopy; diagnostic hysteroscopy and therapeutic hysteroscopy) SIS was the procedure of first choice in the work-up of these women [31].…”