English

Abstract

AIMS AND OBJECTIVES: To compare the results of TVS and SIS with hysteroscopy and histopathological findings. MATERIAL AND METHOD: This prospective study was conducted in patients attending the outpatient clinic with perimenopausal & postmenopausal bleeding. They all were subjected to transabdominal ultrasound to localise the pathology as the screening procedure. Patients with endometrial pathology underwent endometrial biopsy after TVS, Saline Infusion Sonohysterography (SIS) & hysteroscopy. Endometrial tissue was sent for histopathological examination. RESULTS: Sensitivity and specificity of TAS 52.3% & 63.2% while that of TVS is 73.9% &73.7% respectively. Positive Predictive Value and Negative Predictive Value of TVS were also found to be higher than that of TAS and were 77.3% &70% and 63.7% & 53.2% respectively. On comparison of statistical values of TVS with that of hysteroscopy taking histopathology as gold standard, the sensitivity and specificity of TVS were 73.9% and 73.7%, respectively as compared to sensitivity and specificity of hysteroscopy which were 78.3% and 84.7% respectively. The positive predictive value of TVS was 77.3% as compared to 85.4% for hysteroscopy. The sensitivity and specificity of SIS were 77.9% and 83.5%, respectively as compared to sensitivity and specificity of hysteroscopy which were 78.3% and 84.2% respectively. The diagnostic accuracy of SIS was (79.1%) as compared to diagnostic accuracy of hysteroscopy (81 %). Five mm endometrial thickness was taken as a cut - off below which the endometrium was considered normal atrophic and if it is equal or more than 5 mm, endometrial lesion is expected. CONCLUSION: Among TVS, SIS & hysteroscopy it was seen that hysteroscopy has the highest diagnostic accuracy for endometrial pathology. For endometrial pathology the TVS could be used as a first choice diagnostic screening test in the investigation of women with perimenopausal and postmenopausal bleeding. TVS can select those cases in which the likelihood of endometrial pathology is high. SIS has advantages over office hysteroscopy that it is better tolerated by patients and cheaper, moreover, SIS is easy to learn and can be quickly performed with minimal extra equipment as part of an ultrasound examination.