Sonohysterography (SHG) is more sensitive than hysterosalpingography (HSG) in the detection of intracavitary abnormalities.

Abstract

Objective: To determine the sensitivity, specificity, predictive value of a positive and a negative test, of transvaginal (TV) ultrasonongraphy (U/S), sonohysterography (SHG), and HSG in the detection of uterine cavity abnormalities. Design: Volunteers were recruited from patients undergoing routine hysteroscopy as part of their evaluation for infertility. An SHG was performed in the OR just prior to the hysteroscopy. These data were retrospectively compared to findings on outpatient HSG. The clinician performing the SHG was blinded to findings on preoperative HSG. The hysteroscopies were performed within two months of HSG. The results of both the HSG and SHG were compared to hysteroscopic findings. Materials/Methods: Intraoperative SHG was performed with an ULTRAMARK 4 [copy](ATL) US machine affixed with a 5.0/7.5 MHz transducer. Measurements of the uterine and ovarian size, bilayer endometrial stripe thickness, and the presence of abnormalities were recorded. An SHG was then performed with a 5.0F H/S catheter© (Ackrad Lab Inc., Cranford, N.J.) and 10-20 cc’s of sterile saline. The uterus was systematically visualized in saggital and coronal planes. If present any polyps, submucosal myomas, or other abnormalities were measured, and their locations within the uterus and cavity noted. Preoperative HSG’s were performed under fluoroscopic guidance with a standard cone insufflation device and 10-20 cc of sinograffin. All hysteroscopies were performed in the operating room with standard distension media. Results: Although these data are limited by small sample size, sonohysterography appears to be the most specific test for the detection of uterine cavity abnormalities. See table. Results comparing TV U/S, HSG, and SHG to findings at the time of hysteroscopy. Tabled 1TV U/S (%)HSG (%)SHG (%)Sensitivity57100100Specificity8667100PV (+)10078100PV (−)67100100 Open table in a new tab Conclusions: Sonohysterography is likely to be more sensitive and specific than routine transvaginal ultrasound and HSG in the detection of uterine cavity abnormalities. These data suggest sonohysterography should be considered the procedure of choice prior to ovulation induction and ART. Supported By: ACOG/Tambrands Grant for Menstrual Health.