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

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.

Accuracy of saline infusion sonography versus hysteroscopy in the evaluation of uterine cavity abnormalities in infertile women at CHRACERH, Yaounde, Cameroon

“…Many studies have been carried out to compare SIS and HS in evaluating intrauterine abnormalities in several populations. 6,12,13,16 The present study done for the first time in a sub-Saharan population, determined the overall sensitivity, specificity and accuracy to be 81.2%, 86.7% and 86.5% respectively. Similar data have been found by Draz et al with an overall sensitivity of 85%, specificity of 100% and accuracy of 94%.…”

“…12 In the same vein, Tangri et al had both sensitivity and specificity at 88% in their study of 136 infertile women. 6 The previous ones conclude that SIS can be a compromise alternative to HS when this later is not available, thus going in the same line of present African context where HS is still very rare. Summarizing, Seshadri et al in their meta-analysis found that the pooled sensitivity of SIS in the detection of all intrauterine abnormalities was 0.88 (95% confidence interval (CI): 0.85-0.90).…”

“…Tangri et al in their study about 136 infertile women found a sensitivity of 79% and a specificity of 89% for diagnosing polyp by SIS, whereas for diagnosis of submucous fibroids, sensitivity and specificity were 85% and 99% respectively. 6 Nallapati et al found a sensitivity of 90.9% and a specificity of 92.7 for endometrial polyps while the sensitivity and the specificity for diagnosing submucous fibroids were 86.3% and 83% respectively. 13 They all conclude that SIS can be a good alternative to HS with satisfying sensibility and specificity in the evaluation of intracavitary lesions.…”

“…It is performed in a comparatively shorter duration of time, is more cost effective, and is less painful for patients than HS, but hysteroscopy remains the gold standard procedure for uterine cavity assessment providing a real time view, and allowing immediate treatment possible, although it is a costly invasive procedure associated with its share of discomfort and risks. 6 Reports on the diagnostic accuracy of saline infusion sonography are conflicting. Some authors consider a negative saline contrast hysterosonography as proof of a normal uterine cavity, whereas others report insufficient diagnostic accuracy to rely on in clinical practice.…”

Comparison of saline instillation sonography with trans vaginal sonography in abnormal uterine bleeding: a prospective study

“…Focal lesions are more likely to be missed at routine endometrial biopsy because of sampling error and are under diagnosed at trans vaginal sonography (TVS) because of limitations of the double-layer thickness evaluation. [5][6][7][8] Saline infusion sonohysterography (SIS) is a technique that involves placing a catheter into the uterine cavity through the cervical os to inject 5-20ml of sterile saline into the endometrial canal. The saline distends the cavity, pushing the opposed walls of the endometrium apart.…”