The place of transvaginal ultrasonography saline infusion sonohysterography and hysteroscopy in the diagnosis of abnormal uterin bleedings

Abstract

Aim: To establish the accuracy of transvaginal ultrasonography, saline infusion sonohysterography and hysteroscopy indiagnosing uterine pathology in patients with abnormal uterine bleeding.Material and Method: In our study, Transvaginal ultrasonography (TVUSG), saline infusion sonohysterography (SIS) andhysteroscopy were applied to 60 patients in the reproductive period, who did not use any contraception method other thancondom, who did not have chronic and systemic diseases, who applied to our clinic with abnormal uterine bleeding. Dilatation& Curettage (D&C) was applied to all patients after the procedure. Histopathology results obtained with D&C were comparedwith those obtained with TVUSG, SIS and hysteroscopy.Results: Histopathologically, 28 patients (46.7%) endometrial polyp, 4 patients (6.7%) submucous myoma, 10 patients (16.7%)endometrial hyperplasia was in the form of endometrial changes due to cycle irregularities in 18 patients (30%). The sensitivity,specificity, positive and negative predictive values for detection of intracavitary pathology by transvaginal sonography were71.42%, 77.78%, 88.23%, 83.85%. The values determined by saline infusion sonohysterography were respectively 88.89%,90.48%, 80.00%, 95.0% and by hysteroscopy were respectively 100%, 90.00%, 95,24%, 100%.Conclusion: TVUSG and SIS is a cheaper, easier and highly diagnostic value procedure for detecting endometrial pathologiessuch as endometrial polyps and submucous myomas. However, due to the high diagnostic values, low complication rates,direct biopsy and simultaneous treatment, we believe that hysteroscopy will maintain it’s ‘gold standard’ feature in the diagnosisand treatment of endometrial pathologies for many years.