The Accuracy of Endometrial Biopsy and Saline Sonohysterography in the Determination of the Cause of Abnormal Uterine Bleeding

Abstract

This study was conducted to investigate the use of endometrial biopsy and saline sonohysterography in the evaluation of abnormal uterine bleeding. The results of this combination were compared with pathologic results from hysteroscopy/ dilatation and curettage or hysterectomy. Study participants were women aged 25 to 69 years with persistent uterine bleeding despite at least 3 months of medical treatment. Of 144 women who entered the study, 30 did not complete the protocol, including 1 who could not tolerate the pain associated with saline sonohysterography and 20 who did not have surgical treatment. One hundred thirteen patients had an initial endometrial biopsy 6 or 7 weeks before saline sonohysterography. Sonohysterography was performed by placing an inflatable balloon catheter in the cervix. After the balloon was inflated with approximately 2 ml of sterile water, a transvaginal ultrasound probe was inserted into the vagina; the uterine cavity was further distended with 10 to 20 ml of sterile saline solution during the ultrasound examination. Forty-seven women (41.6%) had normal surgical findings (secretory, proliferative, or atrophic endometrium). Sixty-six women had abnormal histopathologic findings, including 37 benign and 2 malignant endometrial polyps. One malignant and 22 benign submucosal myomas were diagnosed. Four women had endometrial hyperplasia. Endometrial biopsy and sonohysterography correctly identified 64 patients with abnormal pathology but failed to diagnosed 2 patients with intrauterine pathology; it did predict negative findings in 2 women who were positive in the surgical specimen. The combination also overdiagnosed 14 women as positive who had negative surgical specimens. Thirty-three patients were correctly identified as negative. The sensitivity and specificity of endometrial biopsy and saline sonohysterography were 0.970 (0.886-0.995) and 0.702 (0.550-0.822), respectively. The positive and negative predictive values were 0.821 (0.714-0.895) and 0.943 (0.796-0.990), respectively.