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

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.

A comparative study of saline infusion sonohysterography and hysterosalpingography for evaluation of female infertility

Background: Infertility is a complex disorder with significant psychological and emotional impact. It affects 10-15% of couples in the reproductive age group. Hence, evaluation of female genital tract is an important part of workup of an infertile woman. The most commonly used methods are hysterosalpingography which exposes the patient to ionizing radiation and laparoscopy which is invasive. This calls for the need of a low risk method that would be suited for ambulatory application. Saline infusion sonohysterography is a cost-effective, safe, non-invasive and a rapid procedure to visualize the female pelvic organ in evaluation of infertility. The objective of this study was to compare diagnostic accuracy of saline infusion sonography (SIS) over conventional hysterosalingography (HSG) for evaluation of female infertility.Methods: Total 50 patients who presented to the gynecology OPD between 2018 to September 2019 for evaluation of infertility were included for the study. The results of the two procedures were compared.Results: For evaluation of uterine cavity, SIS had a sensitivity of 95%, specificity of 100%, PPV of 100%, NPV 75% and a sensitivity of 100%, specificity of 100%, PPV of 91%, NPV of 100% for tubal patency as compared to HSG.Conclusions: For evaluation of uterine cavity, SIS had a sensitivity of 95%, specificity of 100%, PPV of 100%, NPV 75% and a sensitivity of 100%, specificity of 100%, PPV of 91%, NPV of 100% for tubal patency as compared to HSG.

Transvaginal sonography versus saline infusion sonohysterography, which has better diagnosing accuracy in detecting cause of abnormal uterine bleeding in perimenopausal women?

Background: Saline infusion sonohysterography (SIS) is a simple, safe, reliable, effective and well-tolerated method without complications that complements transvaginal sonography (TVS) in the pre-operative examination of uterine pathology. SIS has been found to be superior to TVS in most studies that have compared their effectiveness in detecting intracavitary lesions and has also been found to decrease the number of diagnostic hysteroscopies to as much as 50%. Patients in whom no intracavitary abnormality is detected by SIS require no further evaluation and are best treated with medical therapy.Methods: The observational study was conducted in the postgraduate department of gynaecology and obstetrics, Lalla Ded Hospital, Government Medical College Srinagar. All consecutive patients with perimenopausal abnormal uterine bleeding attending gynaecology OPD were enrolled in the study after taking informed written consent.Results: SIS has better accuracy than TVS in diagnosing the cause of AUB in perimenopausal women. TVS had sensitivity, specificity and PLR of 60 and 93.8, 9.8, respectively for fibroids while polyps had 27.3, 98.8 and 17.5, respectively, AUP had 81.8, 79.2, 3.9 respectively. SIS had sensitivity, specificity, PLR and NLR values of 80.0, 96.9, 40.7 and 0.21, respectively for diagnosing fibroids, while 63.6, 98.4, 26 and 0.37 respectively for polyp, and 90.9, 94.3, 16.1 respectively for AUP.Conclusions: Accuracy of SIS as a test for detecting pathology in AUB in perimenopausal patients is moderately good and suitable for developing countries.

Submucosal adenomyotic cyst successfully treated with hysteroscopic surgery: Two case reports / 대한산부인과학회지

Two women presented with history of vaginal bleeding and abnormal transvaginal ultrasound findings. Saline infusion sonohysterography was done for preoperative evaluation and this imaging study revealed centrally located uterine mass with internal cystic portion. Our initial impression was submucosal myoma with cystic degeneration and hysteroscopic removal of the mass was performed. During the procedure, dark brownish cystic fluid was drained. The excised submucosal mass was pathologically diagnosed as adenomyosis and clinically as submucosal adenomyotic cyst. Submucosal adenomyotic cyst should be part of the differential diagnosis of submucosal uterine masses with cystic portion. We report two cases of submucosal adenomyotic cyst successfully treated with hysteroscopic resection and brief review on this topic.

A case report of tubo-ovarian abscess, a complication of saline infusion sonohysterography.

Saline infusion sonohysterography (SIS) is a widely used procedure for intrauterine lesion diagnosis. It has few side effects and complications. The authors present a case report of a middle-aged Thai woman who presented with metrorrhagia. Malignancy had been ruled out with fractional curettage. Despite hormonal treatment, she had persistent metrorrhagia. SIS was performed and a tubo-ovarian abscess developed. Exploratory laparotomy with TAH and BSO were carried out for treatment.

Diagnostic efficacy of saline infusion sonohysterography and hysteroscopy for intrauterine lesion / 대한산부인과학회지

OBJECTIVE: To compare the diagnostic accuracy and acceptability of saline infusion sonohysterography (SIS), and hysteroscopy for detecting intracavitary abnormalities in women with abnormal uterine bleeding. METHODS: Seventy-eight patients with abnormal uterine bleeding were selected from the Department of Obstetrics and Gynecology in Chonnam University Hospital. The findings at SIS were compared with the hysteroscopic and histologic findings. The agreement of diagnosis between SIS and hysteroscopy was calculated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: SIS had a sensitivity of 84% and a specificity of 85% for a diagnosis of endometrial polyp. Hysteroscopy had a sensitivity of 86% and a specificity of 96% for diagnosis of endometrial polyp. SIS had a sensitivity of 75% and a specificity of 86% for a diagnosis of submucosal myoma. Hysteroscopy had a sensitivity of 100% and a specificity 99% for a diagnosis of submucosal myoma. SIS had a sensitivity of 91% and a specificity of 96% for a diagnosis of submucosal myoma. Hysteroscopy had a sensitivity of 100% and a specificity 91% for a diagnosis of endometrial hyperplasia. CONCLUSIONS: The diagnostic accuracy of SIS was significant to that of hysteroscopy in diagnosing intracavitary abnormalities, Moreover, SIS in a safe, convenient, cost effective, easily accessible and acceptable investigative modality.

The diagnostic value of saline infusion sonohysterography in evaluation of patients with abnormal uterine bleeding / 대한산부인과학회지

OBJECTIVE: To evaluate saline infusion sonohysterography (SIS) as an investigative modality in abnormal uterine bleeding of premenopausal and postmenopausal women. METHODS: Eighty eight patients, 74 premenopausal women and 14 postmenopausal women, with abnormal uterine bleeding were selected. After complete work-up, transvaginal examination were performed followed by SIS. The final surgical-pathologic findings were compared with the results obtained from transvaginal sonography (TVS) and SIS. The sensitivity, specificity, positive and negative predictive value were calculated for each procedure. RESULTS: The SIS was perfomed in 85 cases. It couldn't be done in one premenopausal woman and two postmenopausal women. The uterine cavity was normal in 28 women, 57 cases displayed abnormalities. Seventeen had endometrial polyp, 17 had submucosal myoma, 23 had irregular endometrium. We found that SIS missed five endometrial polyp and mislabeled 14 (38.9%) false positive endometrial growth. On comparing SIS, transvaginal sonography missed nine endometrial polyp and mislabeled 22 (55%) false positive endometrial growth. The sensitivity, specificity, positive predictive value and negative predictive value of TVS were 72.9%, 45%, 61.4% and 58.1%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of SIS were 87.8%, 61.1%, 75.4% and 78.6%, respectively. Sensitivtity and negative predictive value were significantly higher with SIS than TVS. CONCLUSION: The SIS is a safe, convenient, time conserving, cost effective, easily accessible and acceptable investigative modality. It definitely enhance the diagnostic potential of TVS in accessment of endometrium and intracavitary pathologies in women with abnormal uterine bleeding.

A case of focal uterine cystic adenomyoma / 대한산부인과학회잡지

The clinical and pathological features of an apparently unique case of an adenomyoitc cyst of the uterus are reported. The cyst was located within the myometrium of a 30-year-old woman suffering from vaginal bleeding for 6 months. Saline infusion sonohysterography revealed uterine cyst. After excision of the cyst, patient's symptoms improved. On histological examination, the cyst most closely resembled an adenomyotic cyst.

The efficacy of transvaginal sonography , saline infusion sonohysterography , and hysteroscopy for the evaluation of the patients with abnormal uterine bleeding / 대한산부인과학회잡지

OBJECTIVE: To evaluate prospectively the efficacy and accuracy of transvaginal sonography(TVS), saline infusion sonohysterography(SIS) and hysteroscopy in the exploration of the uterine cavity. METHODS: 71 consecutive patients were evaluated with SIS who showed abnormal TVS findings, using saline instilled through endocervically placed balloon catheter with concurrent vaginal sonography. Among them, 41 patients also underwent hysteroscopy and surgery. Transvaginal sonography, sonohysterography, hysteroscopy were compaired with pathologic reports. RESULTS: Fifty-five of 71 sonohysterogram(77.5%) showed abnormal findings, Among them 41 patients have done hysteroscopy and biopsy. According to pathologic reports, sixteen patients were noted to have myoma(39.0%), twelve patients had polyps (21.3%), and both showed most frequent lesions. TVS, SIS, and hysteroscopy had a sensitivity of 94.4%, 91.1%, 94.4%, and a specificity of 40%, 42.8%, 60.0%, respectively and showed not so much different in detection rate. In case of submucosal myoma and polyps, hysteroscopy showed 100% sensitivity, and 92% specificity and showed much higher detection rate compared with SIS (81.2%, 92.0%). CONCLUSION: Transvaginal sonography and sonohysterography are good office diagnostic test in case of detecting variable gynecologic intrauterine abnormalities.