Abstract
Purpose of Investigation: To evaluate technique, advantages, and limits of saline infusion sonography (SIS) in assessment of endometrial, subendometrial, and myometrial pathologies. Materials and Methods: A detailed literature research on MEDLINE, Cochrane library, EMBASE, NLH, ClinicalTrials.gov, and Google Scholar databases was done up to December 2017 restricted to English articles regarding SIS, technique, advantages, and limits. The keywords used for this review were: sonography, ultrasonography, hydrosonography, hysterosonography, saline infusion sonography, and sonohysterosalpingography (sono-HSG) with foam instillation (HyFoSy) versus saline solution (HyCoSy) in the evaluation of tubal patency. Original articles, reviews, and meta-analyses were included. Results: SIS has acquired an important role in the diagnostic work-up of abnormal uterine bleeding (AUB). SIS can be considered as an alternative diagnostic modality to hysteroscopy in detecting endometrial polyps and uterine submucosal leiomyomas. SIS is performed before the beginning of the assisted conception to evaluate the uterine cavity and exclude intracavitary pathologies, such as fibroids and endometrial polyps that could hinder the assisted fertilization procedure. SIS has a similar sensitivity and specificity for tubal patency as hysterosalpingography (HSG), without the inconvenience and potential hazards of HSG, such as possible iodine-based sensitivity to the radiopaque dye and exposure to radiations. Two-dimensional (2D) SIS is already very accurate, therefore both 2D SIS and threedimensional (3D) SIS should be considered alternatives to diagnostic hysteroscopy when intracavitary pathology is suspected in subfertile women and in those with AUB. Conclusions: SIS is a technique indicated in premenopausal and postmenopausal women with abnormal vaginal bleeding and is also a valid procedure for initial outpatient screening in infertility.
Highlights
Saline infusion sonography (SIS) is a technique in which a catheter is placed into the endometrial cavity and sterile saline solution is instilled into the uterine cavity to enhance endometrial and myometrial visualization during transvaginal ultrasonography (TVUS) [1-2]
SIS has acquired an important role in the diagnosis of abnormal uterine bleeding (AUB), establishing itself as a complementary method to conventional TVUS in the evaluation of these cases [12]
The meta-analysis showed good accuracy of Saline contrast sonohysterography (SCSH) in the detection of endometrial and submucosal polyps, and uterine leiomyomas, with a higher sensitivity for the diagnosis of the latter [17]. These results demonstrated that, in women with AUB, 2DSCSH can be considered as an alternative diagnostic modality to hysteroscopy in detecting uterine submucosal leiomyomas
Summary
Saline infusion sonography (SIS) is a technique in which a catheter is placed into the endometrial cavity and sterile saline solution is instilled into the uterine cavity to enhance endometrial and myometrial visualization during transvaginal ultrasonography (TVUS) [1-2]. SIS is indicated in postmenopausal women with abnormal vaginal bleeding, to distinguish bleeding caused by atrophy (the most common reason of bleeding in this age group), from anatomic lesions such as polyp, myoma, hyperplasia, and carcinoma [3]. SIS can be a valuable test in the evaluation of female infertility. It is a safe procedure for the study of uterine cavity with no risk of dissemination of tumoral cells into abdominal cavity in cases of endometrial carcinoma [4]. Synonymous are Saline contrast sonohysterography (SCSH), sonography, ultrasonography, hydro-sonography, hysterosonography, and sonohysterosalpingo- graphy
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