Clinical utility of saline solution sonohysterography in the diagnosis of uterine pathology

Abstract

Sonohysterography involves the instillation of sterile saline solution under continuous sonographic visualization to assess the endometrial cavity. It is the objective of this study to determine the diagnostic accuracy of saline solution infusion sonohysterography and compare the reliability of transvaginal ultrasonography with and without saline solution infusion sonohysterography in detecting intrauterine pathology. The reliability of saline solution infusion sonohysterography were evaluated in 31 patients seen in our institution. These were then compared with the pathological results on available specimens. The sensitivity of transvaginal ultrasonography improved after saline solution infusion sonohysterography from 56 to 94% and the specificity from 40 to 60%. The positive predictive value increased from 75 to 88% and the negative predictive value from 22 to 75%. The diagnostic accuracy also increased from 52 to 86%. When the transvaginal ultrasonography and saline solution infusion sonohysterography results were combined, they had sensitivity of 100%, specificity of 100%, positive predictive value of 89%, negative predictive value of 100% and a diagnostic accuracy of 90%. The use of saline solution infusion sonohysterography also improved the quality of information about the location and size of uterine mass. This development has implications for the management of uterine bleeding disorders. It can distinguish women who only require medical therapy from those who require surgery. The method is easy to learn and is well tolerated by the patients.