A Systematic Review of Imaging for Polyps and Leiomyomas in Women with Abnormal Uterine Bleeding

The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions

“…Regardless of the clinical guideline, when AUB is persistent and either unexplained or inadequately treated, endometrial sampling is necessary—if possible—in association with hysteroscopic evaluation of the uterine cavity . Sonohysterography is likely a reasonable substitute for hysterography to diagnose for polyps and submucous leiomyomas . There exist a number of techniques for endometrial sampling, but it is important that an adequate sample be obtained before the patient can be considered at low risk for a malignant neoplasm …”

“…These generally include hysteroscopy and/or transvaginal ultrasonography with intrauterine contrast, either gel or saline, termed sonohysterography. Which of these techniques is used will depend on the resources available to the clinician . In most instances, sonohysterography will be more readily available, particularly when the only available resources for hysteroscopy reside in an operating room.…”

“…28 Sonohysterography is likely a reasonable substitute for hysterography to diagnose for polyps and submucous leiomyomas. [53][54][55] There exist a number of techniques for endometrial sampling, but it is important that an adequate sample be obtained before the patient can be considered at low risk for a malignant neoplasm. 56 It is apparent that a relationship exists between chlamydial infection of the endometrium and AUB.…”

“…MRI may be occasionally Which of these techniques is used will depend on the resources available to the clinician. [53][54][55] In most instances, sonohysterography will be more readily available, particularly when the only available resources for hysteroscopy reside in an operating room. However, if office hysteroscopy is available, there may be additional value, particularly when polyps are suspected, as hysteroscopically directed polypectomy will be feasible in the same setting.…”

Fly Thru imaging: Feasibility study and comparison with outpatient hysteroscopy

“…Saline contrast sonohysterography (2D‐SIS) is an established method for evaluation of the uterine cavity and has been shown to be superior to transvaginal sonography alone in women with AUB. A recent meta‐analysis involving 25 studies demonstrated that saline sonohysterography in both pre‐ and postmenopausal women complaining of AUB provided a similar detection rate of intracavitary abnormalities to hysteroscopy, with a sensitivity of 93% and specificity of 83% Krampl et al ., in a prospective blinded comparative study, demonstrated that in about 90% of women with AUB, sonohysterography could safely replace diagnostic hysteroscopy …”