The use of transvaginal ultrasonography, sonohysterography, and endometrial biopsy as a diagnostic tool in the evaluation of abnormal uterine bleeding.

Abstract

Objective: To determine the sensitivity, specificity, predictive value of a positive and a negative test, of transvaginal (TV) ultrasonography (U/S), sonohysterography (SHG), and endometrial biopsy in the evaluation of abnormal uterine bleeding (AUB). Design: Volunteers with AUB were recruited in a prospective fashion. Patients underwent pelvic exam, TV U/S, SHG, and endometrial biopsy. Within two months of these studies they underwent hysteroscopy. Volunteers were also recruited from those patients undergoing routine hysteroscopy. These results of all preoperative studies were compared directly to hysteroscopic findings. Materials/Methods: Volunteers underwent U/S exam with an ULTRAMARK 4 ©(ATL) US machine 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. Endometrial biopsies were obtained in the standard fashion with a 5 mm pipelle instrument in the month prior to the U/S studies. TV U/S, SHG, and endometrial biopsy results were compared to hysteroscopic findings. All hysteroscopies were performed in the operating room with standard distension media within 2 months of the U/S studies. Results: 259 women underwent SHG. 109 patients had no intracavitary lesions identified on SHG; 104 elected a change in medical management, 3 had in office D + C’s for focal endometrial thickening and were found to have simple focal hyperplasia, two conceived with ART. The remaining 150 patients underwent office (132) or OR (18) SHG’s. Eleven patients with known abnormal office SHG’s went directly to hysterectomy; 6 myomas, 3 adenomyosis, and 2 persistent menorrhagia and anemia. Three patients with suspected endometrial pathology on SHG did not go to hysteroscopy;1 delayed surgical treatment for complex medical illness, 1 declined surgical intervention, and 1 moved out of the area and was lost to follow up. Of the 136 patients who underwent SHG, and hysteroscopy, 74 had endometrial biopsies. Results of individual tests in the evaluation of DUB. Tabled 1TV U/S (%)SHG (%)Endo Bx (%)Sensitivity559821Specificity51938PV (+)939787PV (−)49953 Open table in a new tab Conclusions: These results indicate that SHG is superior to routine TV U/S and endometrial biopsy in the diagnosis of intrauterine pathology. Endometrial biopsy was most likely to make the diagnosis correctly for hyperplasia, carcinoma, and occasionally for endometrial polyps. The SHG improved the accuracy in differentiating between intracavitary myomas and polyps, and in the location of the lesion. Supported by: ACOG/Tambrands Grant for Menstrual Health.