Transvaginal sonography versus hysteroscopy in evaluation of abnormal uterine bleeding

Abstract

Abnormal uterine bleedingTransvaginal sonography Hysteroscopy Endometrial polyp Submucous fibroid a b s t r a c t Background: Abnormal uterine bleeding (AUB) accounts for 33% of female patients referred to gynaecologists. Common causes of AUB include endometrial polyps, endometrial hyperplasia, submucous fibroids and anovulation. Accurate diagnosis of the cause of AUB can reduce the frequency of hysterectomy. This study was aimed at assessing the usefulness of TVS in comparison with hysteroscopy in AUB evaluation. Methods: 100 female patients with AUB were enrolled in the study. Each patient was subjected to TVS where uterine cavity was studied in detail and hysteroscopy under anaesthesia using saline as distension medium. Sensitivity, specificity and predictive value of TVS as compared to hysteroscopy were calculated. Subgroup analysis within each group was also performed. Results: Menorrhagia was the commonest presenting symptom in the study population (n ¼ 58) followed by metrorrhagia, menometrorrhagia and continuous bleeding >21 days. 74 female patients had normal size uterus. In 57 patients, the uterine cavity was normal on TVS. Thickened endometrium, endometrial polyp and submucous fibroids were seen in 19, 16 and 6 patients respectively. Hysteroscopy showed normal cavity in 59 female patients and polypoidal endometrium, polyps or submucous fibroids in 41. TVS was found to have high sensitivity and specificity (95.23 and 94.82 respectively) and high positive and negative predictive value. Strength of agreement between TVS and hysteroscopy was high (kappa value 0.898). Conclusion: TVS is recommended as first line investigation in AUB. If TVS shows normal cavity, further evaluation can be omitted and patient started directly on medical treatment for her symptoms.© 2014, Armed Forces Medical Services (AFMS). All rights reserved. m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 1 ( 2 0 1 5 ) 1 2 0 e1 2 5http://dx

A Comparative Observational Study of the Use Transvaginal Ultrasound and Hysteroscopy for the Detection of Uterine Cavity Pathologies in Women with Abnormal Uterine Bleeding

“…These observations were similar to those observed by Goyal, B.K. et al who recommended the use of trans vaginal ultrasound solely prior to initiation of treatment whenever there is no abnormal findings could be detected and to consider hysteroscopy whenever there is no response to medical treatment [14].…”

Diagnosis of endometrial pathologies: transvaginal sonography versus hysteroscopy

“…6 Goyal et al found that TVUSG had high sensitivity (95%), specificity (94%), PPV (93%), and NPV (96%) in detecting endometrial pathologies. 7 In present study TVUSG's sensitivity, specificity, PPV and NPV for detecting endometrial pathologies were 77%, 32%, 75% and 32%, respectively. Although the sensitivity, PPV and NPV were similar to previous reports, the specificity of TVUSG in detecting endometrial pathologies was lower than those reported in the literature.…”

Comparison of endometrial assessment by transvaginal ultrasonography and hysteroscopy

“…Two recent studies also demonstrated the high accuracy of ultrasonography in the diagnosis of endometrial disease among reproductive‐age women . Those studies recommend that transvaginal ultrasonography should be used as the first step in the investigation of uterine bleeding anomalies.…”

“…12,18,21 Again, this difference could be due to technologic improvements in ultrasonography equipment.Two recent studies also demonstrated the high accuracy of ultrasonography in the diagnosis of endometrial disease among reproductive-age women. 25,26 Those studies recommend that transvaginal ultrasonography should be used as the first step in the investigation of uterine bleeding anomalies. If the uterine cavity shows no anomalies, then further evaluation is not required and treatment of symptoms may be initiated.…”