An evaluation of sonohysterography and diagnostic hysteroscopy for the assessment of intrauterine pathology

Abstract

The availability of advanced hysteroscopic surgical techniques has changed the management of abnormal uterine bleeding. The aim of this study was to evaluate the use of transvaginal sonography (TVS), sonohysterography (SH) and diagnostic hysteroscopy (DH) for the preoperative assessment of the uterine cavity. The plan was to investigate 100 patients with abnormal uterine bleeding despite conventional medical treatment. The endpoints were uterine abnormalities detected by operative hysteroscopy and histology, and subjective estimates of discomfort during TVS and SH. A total of 104 patients (aged 26-79 years) were recruited and 98 (94%) underwent all three diagnostic procedures. Uterine abnormalities were present in 52 patients (53%). There were 25 cases with at least one endometrial polyp, 17 with submucous fibroids, seven with endometrial hyperplasia and three with an adenocarcinoma. The overall sensitivity of TVS improved after SH from 67 to 87% and the specificity from 89 to 91%. The positive predictive value increased from 88 to 92% and the negative predictive value from 71 to 86%. The use of SH also improved the quality of information about the location and size of polyps and submucous fibroids. Increased endometrial thickness associated with adenocarcinoma was detected in all cases (three of three) by TVS and in four of seven cases of hyperplasia (five of seven cases after SH). Most patients reported minor discomfort during TVS or SH and no side-effects were apparent. The sensitivity of DH was 90% (92% for polyps, 88% for fibroids); two cases with a polyp, two with a submucous fibroid and one with endometrial hyperplasia were not detected. The use of saline infusion to enhance visualization of the endometrium increases the diagnostic accuracy of transvaginal sonography to approach that of diagnostic hysteroscopy and also provides some additional information. This development has implications for the management of uterine bleeding disorders.

Three-dimensional sonohysterography for examination of the uterine cavity in women with abnormal uterine bleeding: Preliminary findings

“…In some cases, however, TVUS is not reliable for identifying the nature of the lesions seen (benign proliferation, hyperplasia, polyps, neoplasia) [5,6]. An additional limitation of this method is that it frequently misses certain types of lesions, including tiny polyps or other small lesions [7e9] and submucosal leiomyomas [10].…”

Comparação entre ultrassonografia transvaginal e histerossonografia na avaliação de pacientes com sangramento uterino anormal

“…Additionally, a high NPV was demonstrated, implying a low number of undiagnosed lesions. Schwärzler et al (17) , in a study with 104 patients, have showed that SHG increased the polyps' detection rate from 56% to 84%, however they have observed that the detection of preneoplastic and neoplastic lesions in the endometrium was not improved by SHG. Perhaps, this may be due to the fact that SHG has greater accuracy in the identification of focal lesions than in the diagnosis of diffuse lesions particularly more associated to malignant lesions.…”

“…Sonohysterography allowed a reduction of the number of falsenegative results for polyps from eight to one, increasing the number of false-positive results from one to two. Schwärzler et al (17) have observed that SHG decreased the incidence of false-negative results from 11 to four without increasing the number of false-positive results. Jacques et al for the higher sensitivity and the much higher PPV in the present study's population.…”

Value of Sonohysterography in Preoperative Assessment of Myometrial Invasion for Patients With Endometrial Cancer

“…24 Several studies have shown that SH offers better visualization of the uterine cavity than conventional TVS and is a useful method for evaluating possible endometrial pathologic conditions. [16][17][18][19][20] However, few have attempted to address the application of SH in preoperative evaluation of endometrial cancer because of its potential risk of malignant cell dissemination into the peritoneal cavity.…”