DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20203316

Diagnostic value of saline infusion sonohysterography for detecting endometrial lesion and comparing it with hysteroscopy and histopathology in postmenopausal bleeding

Suwaram Saini, Shweta Jain, Sarla Saini, Manish Bhardwaj

Abstract


Background: Different diagnostic tools are available to evaluate endometrial lesion such as hysteroscopy, sonohysterography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with postmenopausal bleeding (PMB).

Methods: This cross-sectional study recruited 100 married women with chief complain of PMB referred to gynecologic clinics at the Zenana hospital, Jaipur from March 2019 to February 2020. All participants were in the post-menopausal period that showed abnormal endometrial thickness (>4 mm) or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist.

Results: Mean age of women was 57.14 years. It is evident that sensitivity, specificity, positive predictive value and negative predictive value of SIS for the diagnosis of endometrial atrophy was 79.16%, 100%, 100% and 83.87% respectively which is higher than that of hysteroscopy and equivalent to histopathology. SIS and hysteroscopy are equally efficient in diagnosing endometrial polyp and submucous fibroid. And are better than histopathology. Histopathology is better than SIS and hysteroscopy for the diagnosis of endometrial proliferation.

Conclusions: Findings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.


Keywords


Hysteroscopy, Postmenopausal bleeding, Saline infusion sonohysterography, Sonohystrography, Transvaginal ultrasound, Uterine focal lesion

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References


Astrup K, Olivarius Nde F. Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynecol Scand. 2004;83:203-7.

Dijkhuizen FP, Brolmann HA, Potters AE, Bongers MY, Heinz AP. The accuracy of transvaginal ultrasonography in the diagnosis of endometrial abnormalities. Obstet Gynecol. 1996;87:345-9.

Emanuel M, Verdel M, Wamsteker K, Lammes F. An audit of true prevalence of intrauterine pathology: the hysteroscopic findings, controled for patient selection in 1202 patients with abnormal uterine bleeding. Gynecol Endosc. 1995;4:237-41.

Van Hanegem N, Breijer MC, Khan KS, Clark TJ, Burger MP, Mol BW, et al. Diagnostic evaluation of the endometrium in postmenopausal bleeding: an evidence-based approach. Maturitas. 2011;68:155-64.

Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA. 1998;280:1510-7.

Gupta JK, Chien PFW, Voit D, Clark TJ, Khan KS. Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta-analysis. Acta Obstet Gynecol Scand. 2002;81:799-816.

Timmermans A, Opmeer BC, Khan KS, Bachmann LM, Epstein E, Clark TJ, et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: systematic review and meta-analysis. Obstet Gynecol. 2010;116:160-7.

Abu-ghazzeh Y, Shakoury WA, Barqawi R. comparative study of transvaginal hysterosonography and biopsy for the evaluation of postmenopausal bleeding. Ann Saudi Med. 1999;19(2):116-9.

Dubskiny TJ. Value of sonography in the diagnosis of abnormal vaginal bleeding. J Clin Ultrasound. 2004;32(7):348-53.

Fleischer AC. Sonographic assessment of endometrial disorders. Semin Ultrasound CT MR. 1999;20:259-66.

Davis PC, O’Neil MJ, Yoder IC, Lee SI, Mueller PR. Sonohysterographic findings of endometrial and subendometrial conditions. Radiographics. 2002;22:803-16.

Dueholm M, Forman A, Jensen ML, Laursen H, Karacht P. transvaginal sonography combined with saline contrast sonohysterogram in evaluating the uterine cavity in premenopausal patients with abnormal uterine bleeding. Ultrasound Obstet Gynecol. 2001;18:54-61.

Epstein E, Ramirez A, Skoog L, Valentin L. Transvaginal sonography, saline constrast sonohysteroraphy and hysteroscopy for the investiagation of women with postmenopausal bleeding and endometrium >5 mm. Ultrasound Obstet Gynecol. 2001;18:157.

Fong K, Causer P, Atri M, Lytwyn A, Kung R. Transvaginal US and Hysterosonography in postmenpausal women with breast cancer receiving tamoxifen: correlation with Hysteroscopy and Pathologic study. Radiodiagraphics. 2003;23:137-50.

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

Ryu J, Kim B, Lee J, Kim S, Lee Sh. Comparison of transvaginal ultrasonography with hysterography as a screeming method in patients with abnormal uterine bleeding. Korean J Radiol. 2004;5:39-46.

Milingos S, Kallipolitis G, Stefanidis K, Sklia J, Makris N, Loutradis D, et al. Saline contrast hysterography in infertile patients and in women with abnormal uterine bleeding. Eur J Gynecol Oncol. 2005;26:564-70.

Alborzi S, Parsanezhad ME, Mahmoodian N, Alborzi S, Alborzi M. Sonohysterography versus transvaginal sonography for screening of patients with abnormal uterine bleeding. Internat. J Gynecol Obstet. 2007;96:20-3.

Yildizhan B, Yildizhan R, Ozkesici B, Suer N. Transvaginal ultrasonography and saline infusion sonohysterography for the detection of intra-uterine lesions in pre- and post-menopausal women with abnormal uterine bleeding. J Int Med Res. 2008;36(6):1205-13.

Aslam M, Ijaz L, Tariq S, Shafqat K, Meher-Un-Nisa, Ashraf R, et al. Comparison of transvaginal sonography and saline contrast sonohysterography in women with abnormal uterine bleeding: correlation with hysteroscopy and histopathology. Int J Health Sci (Qassim). 2007;1(1):17-24.

Dijkhuizen FP, De Vries LD, Mol BW, Brölmann HA, Peters HM, Moret E, et al. Comparison of transvaginal ultrasonography and saline infusion sonography for the detection of intracavitary abnormalities in premenopausal women. Ultrasound Obstet Gynecol. 2000;15(5):372-6.

Ogutcuoglu B, Karadag C, Inan C, Dolgun ZN, Yoldemir AT, Aslanova L. Diagnostic utility of saline infusion doppler sonohysterography in endometrial mass lesions. Pak J Med Sci. 2016;32(2):284-8.

Gunes M, Erol O, Kayikcioglu F, Ozdegirmenci O, Secilmis OA. Comparison of saline infusion sonography and histological findings in the evaluation of uterine cavity pathologies. Arch Gynecol Obstet. 2008;278(6):513-6.

Chawla I, Tripathi S, Vohra P, Singh P. To evaluate the accuracy of saline infusion sonohysterography (SIS) for evaluation of uterine cavity abnormalities in patients with abnormal uterine bleeding. J Obstet Gynaecol India. 2014;64(3):197-201.

de Kroon CD, Jansen FW, Louwé LA, Dieben SW, van Houwelingen HC, Trimbos JB. Technology assessment of saline contrast hysterosonography. Am J Obstet Gynecol. 2003;188(4):945-9.