Transvaginal saline hysterosonography: a comparison with local anaesthetic hysteroscopy for the diagnosis of benign lesions associated with menorrhagia

Abstract

The objective of this paper is to assess the diagnostic accuracy of transvaginal saline hysterosonography (TVHSg) compared to hysteroscopy in the identification of benign lesions affecting the endometrium in women with menorrhagia. A cross-sectional study was reported according to the Standards for Reporting of Diagnostic Accuracy (STARD) guidelines. These standards were introduced by an international steering committee in order to improve the reporting of diagnostic accuracy studies. The study was carried out at a one-stop menorrhagia clinic at a central teaching hospital in Newcastle Upon Tyne, UK. One hundred and forty patients were referred to the menorrhagia clinic. After clarification of their history, TVHSg was performed on each patient and the findings were recorded on a proforma. The patients then underwent hysteroscopy using local anaesthetic and a Pipelle endometrial biopsy was performed. Each operator was blinded to the findings of the preceding investigation until both proformas had been completed. The diagnostic accuracy of TVHSg was compared to hysteroscopy in the diagnosis of benign intrauterine lesions. TVHSg has a sensitivity of 0.88, a specificity of 0.99, a positive predictive value of 0.96, a negative predictive value of 0.97 and a positive likelihood ratio of 99 in the detection of endometrial polyps. For the detection of submucous fibroids, the sensitivity is 0.86, the specificity is 0.98, the positive predictive value is 0.90, the negative predictive value is 0.97 and the positive likelihood ratio is 49. We conclude that TVHSg has high diagnostic accuracy for the detection of intracavitary lesions in patients with menorrhagia when compared to out-patient hysteroscopy.