Saline contrast hysterosonography in infertile patients and in women with abnormal uterine bleeding

Objective: We conducted this prospective study to evaluate saline contrast hysterosonography (SCHS) as a diagnostic modality for intrauterine lesions in comparison to hysteroscopy and endometrial biopsy.

Materials and methods: We included 135 patients, of whom 70 presented with abnormal uterine bleeding and 65 with subfertility problems. All cases were examined with conventional transvaginal sonography and were further investigated with SCHS using saline as contrast medium, and finally hysteroscopy with endometrial biopsy that was used as the reference test.

Results: SCHS revealed the presence of intrauterine pathology in 23 cases and failed in three (4.2%). SCHS had a sensitivity of 94%, a specificity of 71%, a positive predictive value of 76% and a negative predictive value of 95% in the abnormal uterine group. In subfertile patients, SCHS revealed the presence of intrauterine pathology in 34 cases and had a sensitivity of 96%, a specificity of 74%, a positive predictive value of 79% and a negative predictive value of 95%.

Conclusions: We found that SCHS is an extremely accurate modality for the diagnosis of focal endometrial pathology, compared to diagnostic hysteroscopy.

Saline hysterosonography; Hydrohysterosonography; Hysteroscopy; Transvaginal sonography; Abnomal uterine bleeding

[1] Gimpelson R.J., Rappold N.0.: "A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage". Am. J. Obstet. Gynecol., 1988, 158, 489.

[2] Mihm L.M., Quick V.A., Brumfield J.A., Connors A.F., Finnerty J.J.: "The accuracy of endometrial biopsy and saline sonohysterography in the determination of the cause of abnormal uterine bleeding". Am. J. Obstet. Gynecol., 2002, 186, 858.

[3] Cicinelli E., Romano F., Anastasio P.S., Blasi N., Parisi C.: "Sonohysterography versus hysteroscopy in the diagnosis of endouterine polyps". Gynecol. Invest., 1994, 38, 266.

[4] Campo R., Van Belle Y., Rombauts L., Brosens I., Gordts S.: "Office mini-hysteroscopy". Hum. Reprod. Update, 1999, 5, 73.

[5] Widrich T., Bradley L.D., Mitchinson A.R., Collins R.L.: "Comparison of saline infusion sonography with office hysternoscopy for the evaluation of the endometrium". Am. J. Obstet. Gynecol., 1996, 174, 1327.

[6] Dueholm M., Jensen M.L., Laursen N., Kracht P.: "Can the endometrial thickness as measured by transvaginal sonography be used to exclude polyps or hyperplasia in premenopausal patients with abnormal uterine bleeding?"'. Acta Obstet. Gynecol. Scand., 2001, 80, 645.

[7] Jones K., Bourne T.N.: "The feasibility of a "one-stop" ultrasoundbased clinic for the diagnosis and management of abnormal-uterine bleeding". Ultrasound Obstet. Gynecol., 2001, 17, 517.

[8] Schwarzler P., Concin N., Bosch N., Berlinger A., Wohlgenannt K., Collins W.P. et al.: "An evaluation of sonohysterography and diagnostic hysteroscopy for the assessment of intrauterine pathology". Ultrasound Obstet. Gynecol., 1998, 11, 337.

[9] de V ries L.D., Dijkhuizen F.P., Mo! B.W., Brolmann N.A., Moret E., Heintz A.P.: "Comparison of transvaginal sonography, saline infused sonography and hysteroscopy in the work-up of premenstrual women with abnormal uterine bleeding". J. Clin. Ultrasound, 2000, 28, 217.

[10] Karlsson B., Granberg S., Wikland M., Y lostalo P., Tornd K., Marsal K. et al.: "Trans vaginal ultrasonography of the endometrium in women with postmenopausal bleeding: a Nordic multicenter study". Am. J. Obstet. Gynecol., 1995, 172, 1488.

[11] Dijkhuizen F.P., de V ries L.D., Mol B.W., Brolmann N.A., Peters N.M., Moret E. et al.: "Comparison of transvaginal sonography and saline infusion sonography for the detection of intracavitary abnormalities in premenopausal women". Obstet. Gynecol., 2000, 15, 1.

[12] Williams C.D., Marshbum P.B.: "A prospective study of transvaginal hydrosonography in the evaluation of abnormal bleeding". Am. J. Obstet. Gynecol., 1998, 179, 292.

[13] Krampl E., Boume T., Hurlen-Solbakken N., Istre 0.: "Transvaginal ultrasonography, sonohysterography and operative hysteroscopy for the evaluation of abnormal uterine bleeding". Acta Obstet. Gynecol. Scand., 2001, 80, 616.

[14] Timmerman D., Deprest J., Boume T., Van den Berghe I., Collins W.P., Vergote I.: "A randomised trial on the use of ultrasonography or office hysteroscopy for endometrial assessment in postmenopausal patients with breast cancer who were treated with tamoxifen". Am. J. Obstet. Gynecol., 1998, 179, 62.

[15] Dijkhuizen F.P., Mol B.W., Bongers M.Y., Brolmann N.A., Heintz A.P.: "Cost-effectiveness of the use of transvaginal sonography and saline infusion sonography in the evaluation of menorrhagia [thesis]". Utrecht (The Netherlands), University of Utrecht, 2000, 114.

[16] Carlos R.C., Bree R.L., Abrahamse P.N., Fendrick A.M.: "Cost effectiveness of saline-assisted hysterosonography and office hysteroscopy in the evaluation of postmenopausal bleeding: a decision analysis". Acad. Radiol., 2001, 8, 835.

[17] Parsons A.K., Lense J.J.: "Sonohysterography for endometrial abnormalities: preliminary results". J. Clin. Ultrasound, 1993, 21, 87.

[18) Wamsteker K., de Blok S.: "Diagnostic hysteroscopy: technique and documentation". In: Sutton C.J.G. (ed.). Endoscopic surgery for Gynecologists. London: WB Saunders, 1993, 263.

[19] Goldstein S.R. Zeltser I., Horan C.K., Snyder J.R., Schwartz L.B.: "Ultrasonography-based image for perimenopausal patients with abnormal bleeding". Am. J. Obstet. Gynecol., 1997, 177, 102.

[20] Gaucherand P., P iacenza J.M., Salle B., Rudigoz R.C.: "Sonohysterography of the uterine cavity: preliminary investingations". J. Clin. Ultrasound, 1995, 23, 339.

[21] Epstein E., Ramirez A., Skoog L., Valentin L.: "Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm". Ultrasound Obstet. Gynecol., 2001, 18, 157.

[22] Dessole S., Farina M., Capobianco G., Nardelli G.B., Ambrosini G., Meloni G.B.: "Determining the best catheter for sonohysterography". Fertil. Steril., 2001, 76, 605.

[23] Dueholm M., Forman A., Jensen M.L., Laursen N., Kracht P.: "Transvaginal sonography combined with saline contrast sonohysterography in evaluating the uterine cavity in premenopausal patients with abnormal uterine bleeding". Ultrasound Obstet. Gynecol., 2001, 18, 54.

[24] Cicinelli E., Romano F., Anastasio P.S., Blasi N., Pami C., Galantino P.: "Transabdominal sonohysterography, transvaginal sonography and hysteroscopy in the evaluation of submucous myomas". Obstet. Gynecol., 1995, 85, 42.