The accuracy of endometrial biopsy and saline sonohysterography in determining the etiology of abnormal uterine bleeding

Abstract

Objective: To compare the results of endometrial biopsy and saline sonohysterography to that of D & C/hysteroscopy or definitive surgery in the evaluation of abnormal uterine bleeding. Methods: The study protocol was approved by the Human Investigation Committee. The patient population studied consisted of women presenting to outpatient services complaining of a history of abnormal uterine bleeding who had failed conservative medical management. The study consisted of two arms with a combined total of 120 patients. The prospective arm included 91 patients who underwent endometrial biopsy and saline sonohysterography as outpatients before being evaluated by a definitive surgical procedure such as D & C/hysteroscopy with or without thermal balloon ablation or hysterectomy. The retrospective group included 41 patients who before the initiation of this study had endometrial biopsies and saline sonohysterography performed with subsequent definitive surgical procedures. These charts were reviewed retrospectively and included in the results as a separate group. All saline sonohysterographies and procedures were performed under supervision of the attending staff. Results: The combination of endometrial biopsy and saline sonohysterography had a sensitivity and specificity of 96.2% and 65.7%, respectively. The positive predictive value of a saline sonohysterography study showing an endometrial polyp, submucous myoma, or irregular endometrial contour was 80.6%. A normal saline sonohysterography had a negative predictive value of 92.0%. Conclusions: Endometrial biopsy and saline sonohysterography are useful for the evaluation of abnormal uterine bleeding; however, it is important to recognize the limitations in the predictive value of this diagnostic modality.