Transvaginal sonography and saline infusion sonohysterography in the evaluation of abnormal uterine bleeding

Abstract

Objective: To evaluate the accuracy of transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) in diagnosing submucous fibroids and endometrial polyps in the patients of abnormal uterine bleeding (AUB).

Design: Prospective, comparative study.

Setting: Postgraduate Institute of Medical Sciences, Rohtak.

Population: Fifty patients with AUB underwent TVS and SIS prior to hysterectomy.

Main outcome measures: Comparison of diagnosis of submucous fibroids and endometrial polyps at TVS and SIS with the final diagnosis at hysterectomy ie 'gold standard'.

Results: Both procedures were helpful in detecting submucous fibroids and endometrial polyps. However, SIS was found to be more useful (sensitivity 89.5%, specificity 100%, likelihood ratios of the presence and absence of submucous fibroids of infinity and 0.1 respectively) than TVS (sensitivity 70% and specificity 96.6% and likelihood ratios of 21.2 and 0.3 respectively) for submucous polyps. Saline infusion sonohysterography was also more accurate for endometrial polyps (sensitivity 100%, specificity 97.8%) than TVS (sensitivity 66.6%, specificity 100%). With SIS and TVS, the post-test probability with negative test was 0% and 4%, respectively, thus suggesting that no endometrial polyp would be missed on SIS.

Conclusion: Saline infusion sonohysterography is more accurate in diagnosing submucous fibroids and endometrial polyps in the patients of abnormal uterine bleeding than is TVS. TVS should be included in the standard protocol for the management of AUB. Saline infusion sonohysterography should be reserved for those patients who have centrally located fibroids as they may be submucous.