Endometrial sampling during sonohysterography (SHGes)

Abstract

Purpose: To assess the diagnostic accuracy of sonohysterography (SHG) and endometrial sampling during SHG (SHGes) compared to traditional hysteroscopy and biopsy. Methods: Seventy‐two consecutive patients with irregular bleeding and/or intracavitary abnormalities underwent transvaginal sonography (TVS) and SHG. SHG was performed with a 4.7‐mm intrauterine catheter. In all patients, an endometrial biopsy was performed by a syringe vacuum aspiration at the end of SHG. Procedure‐related pain was assessed. Sonographic findings at SHG were defined as normal, focal lesions or diffuse endometrial abnormality. In patients with diffuse endometrial abnormality, hysteroscopy and hysteroscopic guided biopsy were performed. In patients with focal lesions, an operative hysteroscopy was performed. Pathologic report was the gold standard. Results: Mean age was 48 years (interquartile range 38–54). At SHG, no pain, mild, and severe discomfort was reported by 75, 18 and 7% of patients, respectively. Fifty patients underwent hysteroscopic guided biopsy, 22 operative hysteroscopy. Hysteroscopic findings were compared to SHG–SHGes finding. (A) Benign lesions: in 56 cases SHG and SHG sampling was concordant with pathologic report, in five cases SHG and SHG sampling over diagnosed the endometrial lesion. In five cases, simple hyperplasia was missed by SHG endoemetrial sampling. (B) (pre)Malignant lesions (six cases): in five cases SHG–SHGes was correct. One case of adenocarcinoma was intepreted as atypical hyperplasia at SHG–SHGes. Sensitivity, specificity, positive and negative values of SHG and SHGes for intracavitary abnormalities were 100, 64, 94 and 100%, respectively. Conclusions: SHG and SHGes should be considered a reliable office triage in the management of patients with intracavitary uterine abnormalities, as adequate as hysteroscopic endometrial biopsies.