Comparative study of saline infusion sonography and hysteroscopy for evaluation of uterine cavity in abnormal uterine bleeding

Sowjanya Nallapati, P. Pallavee, Seetesh Ghose


Background: Intra-cavitary uterine pathology is the commonest cause of abnormal uterine bleeding. Hysteroscopy is considered as the gold standard for uterine cavity examination. However, in resource limited set-ups saline infusion sonography is an effective alternative to hysteroscopy. The current study aims to compare the accuracy of saline infusion sonography with hysteroscopy in identifying intra-cavitary lesions in women with abnormal uterine bleeding.

Methods: 52 patients with abnormal uterine bleeding underwent saline infusion sonography followed by hysteroscopy. The parameters studied were endometrial thickness, presence of sub-mucosal fibroid and endometrial polyp.  

Results: Upon comparison of saline infusion sonography with hysteroscopy, for detecting endometrial hyperplasia the  sensitivity, specificity, positive and negative predictive value were 100%, 94%, 40% and 100% respectively. For endometrial polyp the sensitivity, specificity, positive and negative predictive values were 90.90%, 92.68%, 76.92% and 97.43% respectively. Similarly, the sensitivity, specificity, positive and negative predictive values for sub-mucosal fibroid were 86.36%, 83%, 79.16 % and 89.28% respectively.

Conclusions: Saline infusion sonography is a less invasive alternative to hysteroscopy for diagnosis of intra-cavitary lesions in women with abnormal uterine bleeding. 


Saline infusion sonography, Hysteroscopy, Abnormal uterine bleeding, Uterine cavity abnormalities

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Dubinsky TJ. Value of sonography in the diagnosis of abnormal vaginal bleeding. J Clin Ultrasound 2004;32:348-53.

de Kroon CD, Jansen FW. Saline infusion sonography in women with abnormal uterine bleeding: An update of recent findings. Curr Opin Obstet Gynecol. 2006;18:653-57.

Susanna I. An imaging algorithm for evaluation of abnormal uterine bleeding: does sonohysterography play a role? Menopause. 2007;14:823-5.

O’Connell LP, Fries MH, Zeringue E, Brehm W. Triage of abnormal postmenopausal bleeding: a comparison of endometrial biopsy and transvaginal sonohysterography versus fractional curettage with hysteroscopy. Am J Obstet Gynecol. 1998;178:956-61

Abu-Ghazzeh Y, Shakoury WA, Barqawi R. Comparative study of transvaginal hysterosonography and biopsy for the evaluation of post-menopausal bleeding. Ann Saudi Med. 1999;19:116-9.

de Kroon CD, Jansen FW, Louwe LA, Dieben SW, van Houwelingen HC. Technology assessment of saline contrast hystersonography. Am J Obstet Gynecol. 2003;188:945-9.

Farquhar C, Ekeroma A, Furness S, Arroll B. A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Acta Obstet Gynecol Scand. 2003;82:493-504.

Salim R, Lee C, Davies B, Jolaoso E, Ofuasia E, Jurkovic D. A comparative study of three-dimensional saline infusion sonohysterography and diagnostic hysteroscopy for the classification of submucous fibroids. Hum Reprod. 2005;20:253-7.

Haemila FA, Youssef D, Hassan M, Soliman A, Mossad M. A prospective comparative study of 3-D ultrasonography and hysteroscopy in detecting uterine lesions in premenopausal bleeding. Middle East Fertil Soc J. 2005;10:238-43.

Rudra S, Duggal BS, Bharadwaj D. Prospective study of saline infusion sonography and office hysteroscopy. Med J Armed Forces India. 2009;65:332-5.

Botsis D, Papagianni V, Makrakis E, Aravantinos L, Creatsas G. Sonohysterography is superior to transvaginal sonography for the diagnostic approach of irregular uterine bleeding in women of reproductive age. J Clin Ultrasound. 2006;34:434-9.

Dasgupta S, Chakraborty B, Karim R, Aich RK, Mitra PK, Ghosh TK. abnormal uterine bleeding in peri-menopausal age: diagnostic options and accuracy. J Obstet Gynecol India. 2011;61:189-94.

Widrich T, Bradley LD, Mitchinson AR, Collins RI. Comparison of saline infusion sonography with office hysteroscopy for the evaluation of endometrium. Am J Obstet Gynecol. 1996;174:1327-34.

Krampl E, Bourne T, Hurlen-Solbakken H, Istre O. Transvaginal ultrasonography, sonohysterography and operative hysteroscopy for the evaluation of abnormal uterine bleeding. Acta Obstet Gynecol Scand. 2001;80:616-22.

Kamel HS, Darwish AM, Mohamed SA. Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyp. Acta Obstet Gynecol Scand. 2000;79:60-4.

Mihm LM, Quick VA, Brumfield JA, Connors AF Jr, Finnerty JJ. The accuracy of endometrial biopsy and saline sonohysterography in the determination of the cause of abnormal uterine bleeding. Am J Obstet Gynecol. 2002;186:858-60.