Hysterosonography and Transvaginal Ultrasonography for Detection of Intrauterine Lesions in Women with Abnormal Uterine Bleeding

Abstract

Abnormal Uterine bleeding (AUB) is one of the frequent complaints of female patients of all ages.AUB is present in 33% of women referred to gynecologists and this increases to 69% in peri-menopausal and postmenopausal women. About 10 % of postmenopausal bleeding results from endometrial cancer and imaging is the mainstay for its identification. Imaging plays a vital role in differentiating structural lesions like endometrial carcinomas, myomas and polyps which require surgical management from functional disorders requiring medical management. Transvaginal Ultrasonography (TVUS) is the first line imaging modality for AUB after selecting the patients with inconclusive pelvic ultrasonographic results. Hysterosonography (HSG) also plays a pivotal role. Objectives:To compares between TVUS and HSG in the detection and identification of intrauterine lesions in patients with abnormal uterine bleeding, and comparing the sensitivity and specificity of the respective methods in the detection of such lesions. Methods: Thisstudy was conducted in Department ofRadiology, Mayo Hospital Lahore. Fifty women presented with history of abnormal uterine bleeding were included in this study. Pregnancy was ruled out by transabdominal scan. Transvaginal ultrasound and hysterosonography were performed in all the patients. All the data were coded and analyzed using SPSS version 20. Results:Out of 50 patients, 10 patients had intramyometrial fibroid, 11 had submucosal fibroid, endometrial polyp was found in 17 patients and 2 patients had thickened endometrium (thickness > 8mm). The sensitivity and specificity of TVUS was found to be 83.2% and 82.7% respectively whereas HSG showed sensitivity and specificity of 95.4% and 91.5% respectively. In the detection of the submucosal fibroid and endometrial polyp, HSG showed highest sensitivity and specificity as compared totransvaginal ultrasound. Conclusion:Both the TVUS and HSG have comparable sensitivity and specificity in the detection of endometrial disease in patients presented with abnormal uterine bleeding however HSG is more sensitive in the detection of polyps.

Two‐dimensional transvaginal sonography vs saline contrast sonohysterography for diagnosing endometrial polyps: systematic review and meta‐analysis

“…Furthermore, in our meta-analysis all patients underwent both procedures, which allows a direct comparison of both techniques, instead of a parallel comparison, reducing the risk of bias. Schwärzler (1998) 13 Dijkhuizen (2000) 14 Kamel (2000) 15 de Vries (2000) 16 Epstein (2001) 17Bonnamy (2002) 19 Nanda (2002) 18 Alcazar (2004) 21 Valenzano (2005) 23 Guven (2004) 20 Kelekci (2005) 22 Botsis (2006) 24 Erdem (2007) 25 Yildizhan (2008) 26 Grimbizis (2010) 27 Bingol (2011) 28 Bingol (2011) 29 Soguktas (2012) 30 Vathanan (2016) 32 Aniol (2017) 34 Dogar (2017) 33 Fadl (2018) 35 Moradan (2019) 36 Dueholm 2015 Schwärzler (1998) 13 Dijkhuizen (2000) 14 Kamel (2000) 15 de Vries (2000) 16 Epstein (2001) 17Bonnamy (2002) 19 Nanda (2002) 18 Alcazar (2004) 21 Valenzano (2005) 23 Guven (2004) 20 Kelekci (2005) 22 Botsis (2006) 24 Erdem (2007) 25 Yildizhan (2008) 26 Grimbizis (2010) 27 Bingol (2011) 28 Bingol (2011) 29 Soguktas (2012) 30 Vathanan (2016) 32 Aniol (2017) …”

“…Aniol (2017) 34 Dogar (2017) 33 Fadl (2018) 35 Moradan (2019) 36 Dueholm (2015) 31 Schwärzler (1998) 13 Dijkhuizen (2000) 14 Kamel (2000) 15 de Vries (2000) 16 Epstein (2001) 17 Bonnamy (2002) 19 Nanda (2002) 18 Alcazar (2004) 21 Valenzano (2005) 23 Guven (2004) 20 Kelekci (2005) 22 Botsis (2006) 24 Erdem (2007) 25 Yildizhan (2008) 26 Grimbizis (2010) 27 Bingol (2011) 28 Bingol (2011) 29 Soguktas (2012) 30 Vathanan (2016) 32…”

“…Twenty-one of the 25 studies were prospective 13-22 , [24][25][26][27][28][29][30][31]33,34,36 and the four remaining studies were retrospective 12,23,32,35 . Among the latter, the examiners performing the TVS and/or SCSH examinations were blinded to histological results in two studies 12,35 and in the other two this issue was not specified 23,32 .…”

“…Concerning the flow-and-timing domain, the time elapsed between the index test and reference standard was not reported in thirteen studies 15,16,19,20,23,24,[26][27][28][32][33][34]36 .…”

“…For the subanalysis according to menopausal status, 10 12, [14][15][16]18,22,24,29,30,33 of the 25 studies reported data only for premenopausal women, three 17,28,31 reported data only for postmenopausal women and one 23 reported data separately for premenopausal and postmenopausal woman, providing data for a total of 892 premenopausal and 442 postmenopausal women.…”