Objectives: To evaluate diagnostic yield of saline contrast sonohysterography (SHG) in cases of abnormal uterine bleeding (AUB) versus hystroscopic findings as a gold standard for comparison.
Patients & Methods: The study included 100 multiparous women with mean age 41.2±4 years presented with AUB. All patients underwent conventional transvaginal sonography (TVS) followed by saline-contrast SHG and next morning, patients underwent therapeutic hysteroscopy for assurance of sonographic findings and management of detected pathology if possible. Pain sensation during and 1-minute after saline instillation was evaluated using 10-point visual analogue scale (VAS). After the end of the procedure, patients’ satisfaction was evaluated using a 5-point satisfaction score.
Results: Mean pain VAS score was decreased significantly (p=0.0007) at 1-min after compared to at time of instillation. All patients found saline SHG a satisfactory procedure with a mean satisfaction score of 3.7±0.6; range: 3-5. Hysteroscopy defined 79 patients had focal lesions, while 21 patients were free of focal lesions. In comparison to hysteroscopic findings, the sensitivity rate of TVS and SHG for detection of focal uterine lesion was 24.1% and 89.9%, respectively and the specificity rate was 52.4% and 78.6%, respectively. Positive predictive (PPV) and negative predictive values (NPV) of TVS were 65.5% and 15.5% for TVS and 94% and 67.3% for SHG. Comparison of test validity characters showed significantly higher (p=0.008) accuracy of diagnosis using SHG compared to TVS.
Conclusion: Office saline SHG is a safe and reliable procedure and is easy to perform with high patients’ satisfaction rates and acceptable coincident pain. It provides significantly higher accurate diagnosis of uterine intracavitary lesions so can be used as a preliminary screening test for women with AUB and its high specificity and PPV could spare more invasive diagnostic modalities and reduces resources.
|
