F06Transvaginal sonography, hydrosonography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium ≥ 5 mm

Abstract

ObjectiveTo determine the ability of transvaginal ultralsound, with or without saline infusion (hydrosonography), to detect focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium ≥ 5 mm, and to determine the accuracy of conventional ultrasound, hydrosonography and hysteroscopy with regard to diagnosing endometrial polyps, submucous myomas and uterine malignancy.MethodsIn a proscpective study 105 women with postmenopausal bleeding and endometrium ≥ 5 mm, underwent conventional ultrasound examination and hydrosonography. Diagnostic hysteroscopy, D & C, and hysteroscopic resection were the performed. The presence of focally growing lesions, and the type of lesion (e.g. endometrial polyp, submucous myoma or malignancy) were noted at ultrasound examination and at hysteroscopy. The endpoints were focally growing lesions detected at hysteroscopy and final pathological diagnosis.ResultsThere was almost perfect agreement (96%) between hydrosonography and hysteroscopy with regard to detecting focally growing lesions. Hydrosonography and hysteroscopy both had a sensitivity of around 80% with regard to endometrial polyps (false positive rate 24% and 6%, respectively), whereas conventional ultrasound missed half of the polyps (sensitivity 49%, false positive rate 19%). Hysteroscopy was superior to both hydrosonography and conventional ultrasound for discrimination between benign and malignant lesions in the uterine cavity (sensitivity 84%, 44%, and 60%; false positive rate 15%, 6%, and 10%). We found a seven fold increased risk of malignancy in women with distension problems at hydrosonography (odds ratio 7.3, 95% CI 1.9–27.8).ConclusionHydrosonography is as good as hysteroscopy at detecting focally growing lesions in the uterine cavity in women with postmenopausal bleeding. However, neither hysteroscopy nor hydrosonography can reliably discriminate between benign and malignant focal lesions. Distension problems at hydrosonography should raise a suspicion of malignacy.