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.

Value of sonohysterography in diagnosis post-cesarean section scar diverticulum / 中国医学影像技术

Objective To explore the value of sonohysterography (SHG) in diagnosis of post-cesarean scar diverticulum.Methods Totally 28 patients with post-cesarean scar diverticulum suspected clinical underwent SHG and conventional transvaginal ultrasound (TVS).The sizes of the diverticulum and the thickness of muscular layer were observed and the diagnostic value of SHG and TVS were compared.All patients underwent hysteroscopy,and the results were considered as diagnostic standard.Results Twenty diverticulums were found by hysteroscopy,20 diverticulums by SHG and 17 diverticulums by TVS.Taking hysteroscopy as diagnostic standard,the accuracy of SHG,TVS in diagnosis of diverticulums were 100％ (20/20) and 89.29％ (17/20) respectively.Superoinferior diameter ([9.17 ± 2.63] mm),left-right diameter ([11.76± 5.67]mm) of diverticulum and thickness of muscular layer ([3.29 ± 1.01]mm) measured by TVS had statistical differences compared with those measured by SHG (superoinferior diameter:[12.01± 4.04]mm,left-right diameter:[12.37±6.14]mm,thickness:[2.85±1.30]mm,all P＜0.05).The altitude of diverticulum measured by TVS and SHG had no statistial difference ([5.62±± 2.13]mm vs [5.50±2.34]mm,P＞0.05).Five patients with intra uterine adhesions,4 with endometrial polyps and 1 with submucosal myoma were detected by SHG.Conclusion SHG has clinical value in di agnosis of post-cesarean scar diverticulum..

Sensibilidad de la ecografía transvaginal e histerosonografía en relación a la histeroscopia en pacientes con infertilidad

Objetivo: Determinar la sensibilidad diagnóstica de la ecografía transvaginal e histerosonografía en relación a la histeroscopia en mujeres con infertilidad. Diseño: Estudio descriptivo. Institución: Clínica de Fertilidad Procrear, Lima, Perú. Participantes: Mujeres atendidas por infertilidad. Métodos: Estudio de pacientes que acudieron por infertilidad entre enero y diciembre 2013 y que fueron sometidas a histeroscopia quirúrgica. Se analizó los resultados de las ecografías transvaginales e histeronosonografías realizadas previo a la cirugía, determinándose los diagnósticos más frecuentes y la sensibilidad de los estudios. Se utilizó el programa SPSS 15 para el análisis. Principales medidas de resultados: Sensibilidad de la ecografía transvaginal, la histerosonografía y la histeroscopia. Resultados: Se realizaron 118 histeroscopias quirúrgicas. La ecografía transvaginal tuvo una sensibilidad de 44,9% (53/118) para cualquier anormalidad respecto a la histeroscopia, y la histerosonografía sensibilidad de 95,7% (113/118). Los hallazgos histeroscópicos fueron pólipo endometrial 74 (62,7%), sinequia uterina 30 casos (25,4%), miomas submucosos 12 casos (10,2%) y otros, 2 casos (1,7%). En relación a las sinequias uterinas, la ecografía transvaginal solo tuvo sensibilidad de 3% y la histerosonografía sensibilidad de 86,6%; para los pólipos endometriales conjuntamente con los miomas submucosos, la ecografía transvaginal tuvo sensibilidad de 45,3% y la histerosonografía de 93%. Conclusiones: La histerosonografía tuvo mejor sensibilidad que la ecografía transvaginal para detectar patología endometrial que afectaba la fertilidad. Además permitió valorar la permeabilidad endocervical, por lo que se propone sea parte del estudio de las mujeres con infertilidad. La histeroscopia fue el patrón de oro como método diagnóstico y terapéutico por su alta sensibilidad, confirmado por los resultados de anatomía patológica.

Objective: To determine the diagnostic sensitivity of transvaginal ultrasonography and sonohysterography compared with hysteroscopy in patients with infertility. Design: Descriptive study. Setting: Procrear Fertility Clinic, Lima, Peru. Participants: Women with infertility. Methods: Between January and December 2 013 patients studied for infertility underwent surgical hysteroscopy; corresponding transvaginal ultrasound and hysterosonography prior to surgery were analyzed for most frequent diagnoses and sensitivity of the studies. Analysis was done using SPSS 15 software. Main outcome measures: Sensitivity of hysteroscopy, transvaginal ultrasound, and hysterosonography. Results: One hundred and eighteen surgical hysteroscopies were performed. Prior transvaginal ultrasound had sensitivity of 44.9% (53/118) for any abnormalities in regards to hysteroscopy, and sonohysterography had sensitivity of 95.7% (113/118). Hysteroscopic findings were endometrial polyp in 74 (62.7%), uterine synechiae in 30 cases (25.4%), submucosal fibroids in 12 (10.2%) and other in 2 cases (1.7%). In relation to uterine synechiae, transvaginal ultrasound alone had sensitivity of 10% and hysterosonography sensitivity of 86.6%, and transvaginal ultrasound had sensitivity of 45.3% and hysterosonography sensitivity of 93% for endometrial polyps along with submucosal fibroids. Conclusions: Hysterosonography had better sensitivity than transvaginal ultrasonography for detecting endometrial pathology affecting fertility. It also assessed endocervical permeability, suggesting its value in the study of women with infertility.

Resultados histerosonográficos en pacientes con infertilidad

Objetivos: Describir los hallazgos de la histerosonografía de mujeres en estudio de infertilidad y en relación a su edad. Diseño: Estudio descriptivo retrospectivo. Institución: Clínica Procrear, Lima, Perú. Participantes: Mujeres en estudio por infertilidad. Métodos: Se realizó el procedimiento de histerosonografía en 305 pacientes, como parte del estudio de infertilidad, entre enero y abril del 2013. Para su análisis se usó el programa SPSS 15. Principales medidas de resultados: Hallazgos en la cavidad endometrial. Resultados: Se realizaron 305 procedimientos en pacientes con promedio de edad de 36 años. Hubo hallazgos anormales de la cavidad endometrial en 25,2% (77/305) de los casos, siendo los más comunes los pólipos endometriales en 50 (16,4%), las sinequias uterinas en 9 (3%), miomas submucosos en 6 (2%) y otros en 12 casos. De estas patologías, el grupo etario que presentó más patologías intrauterinas fue el de 31 a 40 años en 29%, y el grupo etario con menos patologías el de 18 a 30 años, con solo 13% de anormalidad. Conclusiones: La histerosonografía es un procedimiento que debería realizarse a todas las pacientes con infertilidad, porque mejora la evaluación de la cavidad endouterina, evitaría fallos de implantación por patología endometrial y permite valorar la permeabilidad del endocérvix.

Introduction: Congenital anomalies and acquired diseases of the uterus have been obstacles for successful treatment of infertility. The uterine cavity is where the embryo normally implants. It is important a proper evaluation of the uterine cavity to rule out or detect changes that may affect implantation. Hysterosonography is a diagnostic method used in the evaluation of the uterine cavity. The most common indication for sonohysterography in patients with infertility is suspected intrauterine pathology. Objectives: To describe routine sonohysterography findings in an infertile population, with or without suspicion of endometrial pathology, in relation to patients age. Design: Descriptive retrospective study. Setting: Clínica Procrear, Lima, Peru. Participants: Women in evaluation for infertility. Methods: Between January and April 2013 hysterosonography was performed in 305 patients as part of infertility study. SPSS 15 program was used for analysis. Main outcome measures: Findings in the uterine cavity. Results: Average age of patients was 36 years. Endometrial cavity abnormal findings was found in 25.4% (77/305) of cases; most common findings were endometrial polyps in 50 (16.4%), uterine synechiae in 9 (3%), submucosal fibroids in 6 (2%) and other pathology in 12 cases. The age group presenting more intrauterine pathology was the 31-40 years group (29%) and the age group with less pathology was the 18-30 years group (13%). Conclusions: Hysterosonography is a procedure that should be performed in all patients with infertility because it improves uterine cavity evaluation, thereby preventing implantation failure and allowing endocervical permeability.

Comparação entre ultrassonografia transvaginal e histerossonografia na avaliação de pacientes com sangramento uterino anormal / Comparison between transvaginal ultrasonography and sonohysterography in the assessment of patients with abnormal uterine bleeding

OBJETIVO: Avaliar a eficácia da ultrassonografia transvaginal (USTV) e da histerossonografia (HSG) e compará-las na avaliação de alterações endometriais em portadoras de sangramento uterino anormal. MATERIAIS E MÉTODOS: Estudo transversal com 30 pacientes, idade entre 29 e 71 anos, 21 delas (70 por cento) na pré-menopausa e 9 (30 por cento) na pós-menopausa. Utilizou-se solução salina a 0,9 por cento para contraste na HSG. Foi considerado o achado histeroscópico e/ou histopatológico como método padrão. Utilizou-se o teste de MacNemar para comparação dos testes diagnósticos. RESULTADOS: A histeroscopia diagnosticou 18 casos (60 por cento) de alterações intracavitárias, sendo 10 pólipos (33,3 por cento). A USTV apresentou sensibilidade e especificidade de 83,3 por cento e a HSG mostrou sensibilidade de 94,4 por cento e especificidade de 91,6 por cento. O teste de MacNemar evidenciou sensibilidade (p = 0,500) e especificidade (p = 1,000) semelhantes entre a USTV e a HSG para detecção de alterações endometriais. No diagnóstico de pólipo, a HSG apresentou maior sensibilidade (90,9 por cento × 27,3 por cento; p = 0,016), com especificidade semelhante (89,5 por cento × 94,7 por cento; p = 1,000). CONCLUSÃO: A HSG e a USTV apresentam boas taxas de predição para doenças endometriais em pacientes com sangramento uterino anormal. A HSG apresenta sensibilidade e especificidade semelhantes às da USTV na detecção dessas doenças, porém apresenta sensibilidade maior para pólipos.

OBJECTIVE: To comparatively evaluate the effectiveness of transvaginal ultrasonography (TVUS) and sonohysterography (SHG) in the assessment of endometrial diseases in women with abnormal uterine bleeding. MATERIALS AND METHODS: Cross-sectional study with 30 patients, aged from 29 to 71 years, 21 (70 percent) of them premenopausal and 9 (30 percent) postmenopausal. Saline solution (at 9 percent) was utilized as contrast agent for SHG. The MacNemar test was utilized for comparison of diagnostic studies. RESULTS: Hysteroscopy diagnosed 18 cases (60 percent) of intracavitary alterations, and 10 polyps (33.3 percent). TVUS demonstrated 83.3 percent sensitivity and specificity, and SHG showed 94.4 percent sensitivity and 91.6 percent specificity. The MacNemar test showed similar sensitivity (p = 0.500) and specificity (p = 1.000) between TVUS and SHG in the detection of endometrial diseases. In the diagnosis of polyp, SHG showed the highest sensitivity (90.9 percent vs. 27.3 percent; p = 0.016) with similar specificity (89.5 percent vs. 94.7 percent; p = 1.000). CONCLUSION: SHG and TVUS present a good predictive value for endometrial diseases in patients with abnormal uterine bleeding. SHG and TVUS present similar sensitivity and specificity in the detection of such diseases, but SHG is more sensitive in the detection of polyps.

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.

Clinical Usefulness of Transvaginal sonography and sonohysterography in evaluation of endometrial abnormalities / 대한산부인과학회지

OBJECTIVE: The aim of our study is to evaluate the clinical usefulness of transvaginal sonography (TVS) and saline infusion sonohysterography (SHG) in the evaluation of endometrial abnormality. METHODS: We retrospectively reviewed 370 patients with abnormal uterine bleeding or uterine cavity abnormalities confirmed by TVS. SHG was carried out by experienced gynecologist, on the same setting in an outpatient clinic after the performance of TVS. Two hundred nineteen patients aged between 23 and 69 years (mean age 41+/-8.2) had operative hysteroscopy (88.2%), hysterectomy (9.1%) and dilatation/curettage (2.7%) within 3 months which provided a detailed description of uterine cavity. Surgical-pathologic findings were compared with the results obtained from TVS and SHG. RESULTS: The sensitivity and specificity were 71.7% and 31.4% for TVS, and 98.4% and 67.6% for SHG respectively. The positive and negative predictive values were 84.6% and 17.5% for TVS, and 94.3% and 92.3% for SHG, respectively. Twenty one cases showed a discrepancy between the TVS and SHG, and 16 cases showed a discrepancy between SHG and the pathologic diagnosis. Fifty five cases (25%) in TVS were unconfirmed, but SHG showed 51 pathologic confirmed intracavitary lesion. CONCLUSION: SHG is a sensitive tool and is superior to TVS used alone for evaluation of endometrial abnormalities. SHG definitely enhances the diagnostic potential of TVS in assessment of endometrium and intracavitary pathologies.

Diagnostic value of sonohysterography in patients with uterine cavity diseases / 中国微创外科杂志

Objective To evaluate the diagnostic value of sonohysterography (SHG)in uterine cavity diseases. Methods 48 patients suspected to suffer from uterine cavity diseases on the basis of transvaginal sonography underwent sonohysterography,hysteroscopy and biopsy.The results of sonohysterography were compared with those from hysteroscopy and biopsy. Results The diagnostic accuracy,sensitivity,specificity of SHG in detecting abnormal uterine cavities were 93.8%(45/48),91.4%(32/35),100%(13/13) and respectively. Conclusions SHG is a simple,effective and cheap method in the detectiou of uterine cavity diseases.

Hysteroscopic evaluation of the efficacy of sonohysterography for diagnosis of submucosal myoma / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficacy of sonohysterography on exact submucosal myoma. methods: Transvaginal sonohysterography was performed on 45 patients who diagnosed as submucosal myoma and 29 patients who diagnosed as endometrial polyp by classic abdominal or vaginal sonogram, and then they received the diagnostic hysteroscopy at all. RESULTS: In 24 of 45 patients on sonohysterogram, submucosal myoma was diagnosed that was protruded to uterine cavity more than 2/3 of mass. Nine patients had intramural myoma and 12 patients had myoma that protruded only lesser than 1/3 of mass on sonohysterogram. These 21 patients revealed the same finding on hysteroscopy. On hysteroscopy, submucosal myomas were in 20 of 24 patients and polyps were in 3 patients and synechia was in one patients. In 8 of 29 patients on sonohysterogram, endometrial hyperplasia was found and confirmed by hysteroscopy. In 16 of 21 patients whose finding was polyp on sonohsyterogram, polyp was confirmed by hysteroscopy. However hysteroscopic findings were myomas in 3 of 21 patients and synechia in one patients. Therefore in 29 of 74 patients (39.2%), further hysteroscopy was not needed by sonohysterogram. In 65 of 74 patients (87.8%), sonohysterographic findings were same as hysteroscopic findings. CONCLUSION: Sonohysterogram for diagnosis of submucosal myoma and polyp is essential procedure in order to avoid unnecessary hysteroscopy. However differentiation between polyp and submucosal myoma has still some difficulty.

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 Use of Sonohysterography in Infertile Patients / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to assess the usefulness of sonohysterography in the detection of abnormalities of the uterine cavity in infertile patients, compared with other diagnostic methods, such as transvaginal sonography, hysterosalpingography and hysteroscopy. METHODS: Three intrauterine pathologies including intrauterine synechiae, endometrial polyp and submucosal myoma, that could be possible causes of infertility were diagnosed. RESULTS: Transvaginal ultrasonography and hysterosalpingography were able to detect 41.7% and 83.3% of uterine pathologies respectively comparing with sonohysterography to detect all of the uterine pathologies. CONCLUSION: Our results show that sonohysterography is easy, inexpensive, well-tolerated and non-invasive technique with high sensitivity in the detection of uterine pathologies. Therefore the use of sonohysterography for the diagnosis of intrauterine pathologies in infertile patients is highly recommended.

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.

Comparison of Diagnostic Accuracy in Uterine Pathology among HSG, Hysteroscopy, and Sono-Hysterography / 대한산부인과학회잡지

Hysterosalpingography and Hysteroscopy have been used for the detection of intraute-rine pathology such as polyps, submucous myomas, intrauterine adhesion and endometrial hyperplasia or cancer. Recently the ultrasound has also been utilized for the detection of uterine pathology. Therefore the purpose of this study was to evaluate the diagnostic efficacy of SonoHysterography in detection of intrauterine pathology compared with HSG and Hysteroscopy. 32 patients underwent Sono-Hysterography and Hysteroscopy for the evaluation of the uterine pathology from september 1995 to January 1996. Nine of 32 patients had infertility problem and HSG performed prior to Sono-Hysterography and Hysteroscopy. The results are as follows : 1. The patients' ages ranged from 20 to 50 years(median 37.9). 2. All 9 patients with infertility who had positive HSG findings in uterine cavity showed the intrauterine pathology in Sono-Hysterography as well as Hysteroscopy. The detail findings are as follows :septated uterus(n=2), intrauterine adhesion :IUA(n=3), endometrial polyp(n=3), and IUA combined endmetrial hyperplasia(n=1). 3. Twenty two of 23 patients with abnormal uterine bleeding showed the intrauterne pathology and one patient had negative finding in Sono-Hysterography. However, Hysteroscopy revealed positive intrauterine pathology in 22 patients who had abnormal uterine bleeding. One patients who had positive finding in Sono-Hysterograply showed negative by Hysterography. In contrast, one patient who had negative finding in Sono-Hysterography had positive uterine pathology with polyp in Hysteroscopy. The histologic pathology in all 23 patients reported endometrial polyp(n=12), placental polyp(n=2), submucous myoma(n=1), endometrial hyperplasia(n=5), endometrial cancer(n=1), normal endometrial finding(n=2). 4. Sono-Hysterography, therefore, has a sensitivity and positive predictive value of 96.6%, 93.5% respectively. Our study showed a positive Sono-Hysterography is very predictive of the intrauterine pathology. Sono-Hysterography is safe, quick and minimal invasive procedure. So it is an invaluable technique in the evaluation of uterine cavity.