Comparative study between trans vaginal sonography, saline infusion sonography and hysterosalpingography in diagnosis of uterine cavity diseases as compared to diagnostic hysteroscopy in infertile women

ABSTRACT

The purpose of this study was to evaluate the diagnostic accuracy of hysterosalpingography, saline infusion sonography and transvaginal sonography as compared to hysteroscopy in diagnosis of uterine cavity abnormalities in infertile women of more than one year. This study included 60 infertile patients with no malefactor, all patients were subjected to hysterosalpingography, saline infusion sonography, transvaginal sonography and hysteroscopic examinations post-mentsturally to evaluate the uterine cavity. Zagazig University Hospital and Cytogenetic unit. Eight patients were excluded from this study due to different causes and only 52 patients continued in this study. As regard to the polypoid lesions, hysterosalpingography [HSG] showed low diagnostic value 51% sensitivity with 28.7% positive predictive value [ppv], transvaginal sonography had intermediate diagnostic accuracy, sensitivity 75.3% and ppv was 75.3%, while saline infusion sonography had sensitivity and PPV of 100% .In cases with intrauterine adhesions poor results were obtained with transvaginal sonography, however the best results were obtained by saline infusion sonography as the sensitivity and ppv were 76.1% and 43.2% respectively. As Regard to uterine malformation, hysterosalpingography had low sensitivity 43.3% and high specificity 96.2%, while transvaginal sonography and saline infusion sonography demonstrated 100% specificity and 100% ppv. Saline infusion sonography had a diagnostic accuracy of 100% for endometrial hyperplasia while HSG had a poor value. Transvaginal sonoogaphy had sensitivity of 67.6% with PPV of 67.1% in diagnosis of endometrial hyperplasia. Saline infusion sonography was the most accurate diagnostic method for polypoid lesions and endometrial hyperplasia as compared to hysterosalpingography and transvaginal sonography. Its diagnostic accuracy was the same as that of hysteroscopy, but with limitted value in diagnosis of intrauterine adhesions