Accuracy Of Saline Infusion Sonohysterography Research Articles

Comparison of Saline Infusion Sonohisterography (SIS) and Histeroscopy Examination in Abnormal Uterine Bleeding

Introduction: Abnormal uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or that occurs at an irregular time, affecting 20% of the adolescent age group, and 50% of women aged 40-50 years in Indonesia. The causes of AUB are pregnancy, anovulatory dysfunction, uterine leiomyoma, endometrial polyps, endometrial hyperplasia, or endometrial carcinoma. This study aims to compare the accuracy of Saline Infusion Sonohysterography (SIS), hysteroscopy and endometrial histopathology in determining pathological abnormalities in women with AUB.Material and Method: This cross sectional diagnostic study was conducted at General Hospital dr. Kariadi Semarang and its network hospitals in June 2020. Samples were determined by consecutive sampling, including married women, not pregnant, had no genital infection and did not present with any malignancy. Histopathological examination of the endometrium is the gold standard for AUB diagnosis. Research data were obtained from secondary data from patient's medical records including demographic characteristics, clinical history, pregnancy history, SIS examination data, hysteroscopy and endometrial histopathology.Result: There were 51 subjects with a mean age of 31.67 ± 5.21 years. The most common complaints were intermenstrual bleeding (37.3%), followed by irregular menstrual bleeding (21.6%), heavy menstrual bleeding (13.7%), and amenorrhea (5.9%). Sensitivity value of SIS examination ranged from 81.5-100% and specificity ranged from 30.77-100%. Hysteroscopy has a sensitivity value range of 87.5-98% and a specificity value of 62.5-100%.Conclusion: SIS examination could be an alternative for endometrial structural abnormalities diagnosis in AUB if hysteroscopy is unavailable.

Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography, and hysteroscopy in evaluating the endometrial polyps in women with abnormal uterine bleeding: a systematic review and meta-analysis.

IntroductionIn women with abnormal uterine bleeding (AUB), endometrial polyps are a frequent finding, and the risk of a focal (pre)malignancy in a polyp is up to 6%. Because of this reported risk, the detection of polyps in these women is important.AimTo evaluate and compare the diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography, and hysteroscopy in detecting endometrial polyps in women with AUB.Material and methodsThe searches were conducted by two independent researchers to find the relevant studies published from 1/1/2009 until the end of 30/06/2019. We searched for published literature in English language in MEDLINE, EMBASETM, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID), KoreaMed, and LILACS. The risk of bias of every article was evaluated by using QUADAS-2.ResultsAfter selection and quality assessment, 11 studies were included. Based on the random effect model the total prevalence of endometrial polyps in women with abnormal uterine bleeding was 38%. The sensitivity and specificity of saline infusion sonohysterography in diagnosis of endometrial polyps were 0.87 and 0.86, respectively. The sensitivity and specificity of transvaginal ultrasonography were 0.62 and 0.73 and the sensitivity and specificity of hysteroscopy were 0.92 and 0.85, respectively.ConclusionsAlthough that sonohysterography is a safe and relatively cheap method, which allows ruling out or confirming endometrial polyps, it cannot be replaced with hysteroscopy due to the fact that hysteroscopy combined with biopsy is the gold standard for ruling out malignancies in an endometrial polyp.

Comparison of Transvaginal Ultrasound, Saline Infusion Sonohysterography versus Diagnostic Hysteroscopy in Evaluation of Endometrial Cavity Pathology amongst Women with Abnormal Uterine Bleeding in Low Resource Setting

Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The incidence of submucosal fibroids and endometrial polyps was 17.5% and 15.0% via TVS, 47.5% and 20.0% via SIS and 52.5% and 20% via DH respectively. The overall sensitivity, specificity, Positive Predictive Value (PPV), Positive Predictive Value (NPV), and diagnostic accuracy of SIS were 92.1%, 83.3%, 96.9%, 62.5%, and 90.0% while TVS was 38.2%, 100%, 100%, 22.2%, and 47.5%. The sensitivity, specificity, PPV, and NPV of TVS in diagnosis of endometrial polyp were 75.0%, 100%, 100%, and 94.0%. SIS did better with a sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%. Conclusion: Our data suggests SIS had a higher diagnostic accuracy than TVS and showcased a comparable diagnostic accuracy to hysteroscopy. SIS is more suitable safe alternative technique for investigating AUB in pre/post-menopausal women in low resource setting where hysteroscopy is unavailable or unaffordable.

Diagnostic accuracy of saline infusion sonohysterography for evaluation of uterine cavity abnormalities in patients with abnormal uterine bleeding

Objectives: The objective of this study was to evaluate the diagnostic accuracy of saline infusion hysterosonography for detection of uterine cavity abnormalities using Hysteroscopy as the gold standard. Study Design: Analytical Quasi Experimental study. Setting: Obstetric and Gynaecology Department Madina Teaching Hospital Faisalabad. Period: July 2017 to December 2017. Materials and Methods: Sixty patients presented with abnormal uterine bleeding were included in the study. Transvaginal ultrasound, SIS and hysteroscopy performed for evaluation of the uterine cavity for any abnormality. Results: SIS helped in detection of intacavitary abnormalities in 39 out of 60 patients indicating sensitivity of 88. 64 % and specificity of 100 % as hysteroscopy confirm the findings in all the patients. The NPV is 76 % and PPV of 100 % taking hysteroscopy as gold standard. The diagnostic accuracy of saline infusion sonography is 91%. Conclusion: The addition of SIS to TVS significantly improved the sensitivity and specificity for detecting intracavitary pathology. It can be used as an alternative procedure whenever hysteroscopy is not available.

Imaging for Polyps and Leiomyomas in Women With Abnormal Uterine Bleeding: A Systematic Review.

To evaluate the accuracy of saline infusion sonohysterography in comparison with transvaginal ultrasonography for diagnosing polyps and submucosal leiomyomas in women with abnormal uterine bleeding. We searched the databases MEDLINE, EMBASE, CENTRAL, and ClinicalTrials.gov as well as citations and reference lists to the end of November 2015. Two authors screened 5,347 citations for eligibility. We included randomized controlled trials or prospective cohort studies published in English, assessing the accuracy of saline infusion sonohysterography and transvaginal ultrasonography for diagnosing polyps and submucosal leiomyomas in women with abnormal uterine bleeding. We considered studies using histopathologic specimens obtained at either hysteroscopy or hysterectomy as criterion standard. Twenty-five studies were eligible. Two authors extracted data and assessed the quality of included studies. Bivariate random-effects models were used to compare the different tests and evaluate sources of heterogeneity. Saline infusion sonohysterography was superior to transvaginal ultrasonography with pooled sensitivity and specificity of 0.92 and 0.89 compared with 0.64 and 0.90, respectively (P<.001). Transvaginal ultrasound sensitivity for diagnosing polyps was particularly low (0.51). Saline infusion sonohysterography was also compared with hysteroscopy in seven studies and had similar sensitivity but inferior specificity (0.93 and 0.83 compared with 0.95 and 0.90, respectively, P=.007). All three procedures were well-tolerated by women. Saline infusion sonohysterography was successfully completed in 95% of women. Technical variations such as the use of balloon catheters were not found to affect diagnostic accuracy. Transvaginal ultrasonography lacks sensitivity to be used alone to exclude the presence of polyps and leiomyomas in women with abnormal uterine bleeding. Although less specific than hysteroscopy, saline infusion sonohysterography offers a similar detection rate and permits concomitant visualization of the ovaries and myometrium. Cost, convenience, and tolerability of different imaging techniques require further evaluation. PROSPERO International prospective register of systematic reviews, http://www.crd.york.ac.uk/PROSPERO, CRD42016034005.

Comparison between findings of saline infusion sonohysterography and office hysteroscopy in patients with recurrent implantation failure.

AIM:This study aims to determine the accuracy of saline infusion sonohysterography (SIS) in the diagnosis of intrauterine pathologies in women with recurrent implantation failure (RIF).SETTINGS AND DESIGN:This is a prospective cross-over study which was carried out during the period between December 2013 and July 2014.MATERIALS AND METHODS:The study involved sixty subfertile women with a history of RIF. All cases underwent a transvaginal ultrasonography, SIS and then an office hysteroscopy (1 day after SIS) during early follicular phase. SIS was carried out by same sonographer, and then hysteroscopy was carried out by same gynecologist who was kept blind to findings at SIS.STATISTICAL ANALYSIS:Was done using IBM© SPSS© Statistics version 22. The sensitivity of SIS was calculated as it equals: True positive by SIS/all positive (true cases by hysteroscopy) and specificity was calculated as it equals: True negative by SIS/all negatives (normal by hysteroscopy).RESULTS:Overall uterine abnormalities were significantly less likely to be identified with SIS compared to hysteroscopy (P = 0.002), but analysis of each finding separately demonstrated a comparable difference between SIS and hysteroscopy (P > 0.05). We found that the sensitivity, specificity, positive predictive value, and negative predictive value of SIS to detect intrauterine pathology is 41.2%, 100%, 100%, and 81.1%, respectively.CONCLUSION:Our findings suggest a good role of SIS in the workup for RIF saving more invasive procedure for selected cases.

English

AIMS AND OBJECTIVES: To compare the results of TVS and SIS with hysteroscopy and histopathological findings. MATERIAL AND METHOD: This prospective study was conducted in patients attending the outpatient clinic with perimenopausal & postmenopausal bleeding. They all were subjected to transabdominal ultrasound to localise the pathology as the screening procedure. Patients with endometrial pathology underwent endometrial biopsy after TVS, Saline Infusion Sonohysterography (SIS) & hysteroscopy. Endometrial tissue was sent for histopathological examination. RESULTS: Sensitivity and specificity of TAS 52.3% & 63.2% while that of TVS is 73.9% &73.7% respectively. Positive Predictive Value and Negative Predictive Value of TVS were also found to be higher than that of TAS and were 77.3% &70% and 63.7% & 53.2% respectively. On comparison of statistical values of TVS with that of hysteroscopy taking histopathology as gold standard, the sensitivity and specificity of TVS were 73.9% and 73.7%, respectively as compared to sensitivity and specificity of hysteroscopy which were 78.3% and 84.7% respectively. The positive predictive value of TVS was 77.3% as compared to 85.4% for hysteroscopy. The sensitivity and specificity of SIS were 77.9% and 83.5%, respectively as compared to sensitivity and specificity of hysteroscopy which were 78.3% and 84.2% respectively. The diagnostic accuracy of SIS was (79.1%) as compared to diagnostic accuracy of hysteroscopy (81 %). Five mm endometrial thickness was taken as a cut - off below which the endometrium was considered normal atrophic and if it is equal or more than 5 mm, endometrial lesion is expected. CONCLUSION: Among TVS, SIS & hysteroscopy it was seen that hysteroscopy has the highest diagnostic accuracy for endometrial pathology. For endometrial pathology the TVS could be used as a first choice diagnostic screening test in the investigation of women with perimenopausal and postmenopausal bleeding. TVS can select those cases in which the likelihood of endometrial pathology is high. SIS has advantages over office hysteroscopy that it is better tolerated by patients and cheaper, moreover, SIS is easy to learn and can be quickly performed with minimal extra equipment as part of an ultrasound examination.

To Evaluate the Accuracy of Saline Infusion Sonohysterography (SIS) for Evaluation of Uterine Cavity Abnormalities in Patients with Abnormal Uterine Bleeding.

To evaluate the accuracy of transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) for detection of uterine cavity abnormalities in patients with abnormal uterine bleeding (AUB) taking hysteroscopy as the gold standard. This was a prospective study done in the department of Obstetrics and Gynecology of a tertiary care academic hospital. Sixty premenopausal and postmenopausal women who presented with AUB underwent TVS, SIS, and hysteroscopy. The presence of focal abnormality and the type of abnormality, i.e., polyp, submucous myoma, and endometrial hyperplasia, were noted. The results of TVS and SIS were compared with hysteroscopy. On hysteroscopy, 76.67% (n=46) patients were diagnosed with intra cavity abnormalities. SIS showed sensitivity, specificity, PPV, and NPV of 89.1, 100, 100, and 73.7%, respectively. In comparison, TVS showed sensitivity, specificity, PPV, and NPV of 43.48, 78.57, 86.96, and 29.73%, respectively. SIS was found to be more sensitive and specific than TVS in detection of intra cavity abnormalities.

Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy

We aimed to compare the accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) for uterine pathologies among infertile women. A total of 346 patients were selected for operative hysteroscopy, following SIS after TVS. SİS was performed with a Cook Soft 500 IVF catheter. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated to compare the accuracy of TVS, SIS and hysteroscopy for uterine abnormalities. SIS showed a sensitivity of 87%, specificity of 100% and PPV of 100% for endometrial hyperplasia, and a sensitivity and NPV of 100% for polypoid lesions. For submucosal myoma SIS showed a sensitivity of 99% with PPV of 96%. Hysteroscopy had a sensitivity, specificity, PPV and NPV of 98%, 83%, 96% and 91%, respectively for overall uterine pathologies. Finally, SIS seems to be superior to TVS, for uterine pathologies, with respect to hysteroscopy as the gold standard.

Acceptability and accuracy of saline infusion sonohysterography in women with postmenopausal bleeding.

To validate the diagnostic efficacy of saline infusion sonohysterography (SIS) in the evaluation of uterine cavity,in women with postmenopausal bleeding and endometrial thickness (3) 5 mm. Cross-sectional study. Military Hospital, Rawalpindi, from March 2005 to July 2008 and Combined Military Hospital, Multan, from September 2008 to June 2009. Seventy seven eligible participants included women complaining of postmenopausal bleeding were included; out of whom 69 completed the procedure satisfactorily. Pain scores during procedure were assessed to determine patient acceptability. Following saline infusion sonohysterography all patients also underwent an out door pipelle endometrial biopsy in a one-stop postmenopausal bleed clinic. Findings of sonohysterography were compared with hysteroscopy/hysterectomy specimen. Majority of the patients 34 (49.2%) experienced no pain during the procedure, 51 (74%) women had a positive SIS and the findings were negative in 18 (26%) patients. The commonest abnormal finding on SIS was focal thickening in 23 (32%) and endometrial polyp in 12 (17%) cases. Saline infusion hysterosonography picked up 3 cases of false positive polyps (5.8%) and missed a case of submucous fibroid near cervix (1.8%). Upon comparison of findings of hysteroscopy and hysterectomy in 53 cases, there was complete agreement in a total of 43 (88%) cases. The sensitivity of sonohysterography was 92% and specificity was 78%. All the ladies with abnormal SIS had diagnostic or therapeutic procedures and finally only 24 (35%) were managed on conservative follow-up. Normal SIS led to conservative management in 16 (88%). Sonohysterography in combination with endometrial biopsy is a useful technique useful for the evaluation of postmenopausal bleeding. Patient acceptability and diagnostic capability is high and it reduces demand for hysteroscopy.

Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy in postmenopausal bleeding

To compare the diagnostic accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) with respect to pathological diagnosis in the detection of uterine cavity abnormalities associated with abnormal uterine bleeding among postmenopausal women. Being a prospective, investigator-blind trial, the present study was conducted on 137 postmenopausal women, with abnormal uterine bleeding, admitted to the Department of Obstetrics and Gynecology of Istanbul Bilim University, Florence Nightingale Hospital and Fertigyn Woman Health and IVF Center. After TVS, all patients underwent SIS using Cook Soft 500 IVF transfer catheter and HS, consecutively. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated to compare the diagnostic accuracy of TVS, SIS and HS. Most commonly encountered endometrial lesions were polypoid lesion (38.0%) and hyperplasia (28.4%) among our study population consisting of 137 women (mean age 61.6 ± 9.6 years) in their postmenopausal stage. Overall sensitivity rates were 70.0% for TVS, 89.6% for SIS and 92.3% for HS, while the overall specificity rates were 50.0, 77.3 and 80.7%, respectively. HS had PPV of 96.2% and NPV of 65.3%, whereas PPV was determined to be 80.9 versus 95.3% and NPV was 35.4 versus 58.3% for TVS and SIS, respectively. As an easy to perform, safe and well-tolerated procedure yielding high diagnostic accuracy, saline infusion SIS via this catheter seems to be superior to TVS and very close to HS. It may be used as the primary method for the detection of uterine abnormalities among postmenopausal women with abnormal uterine bleeding.

Saline infusion sonohysterography – an effective tool for evaluation of the endometrial cavity in women with abnormal uterine bleeding

We evaluated the diagnostic accuracy of saline infusion sonohysterography (SISH) over transvaginal sonography (TVS) for the detection of intrauterine abnormalities using hysteroscopy as the gold standard in a retrospective study of 70 women mostly presenting with abnormal uterine bleeding. TVS was normal in 32 women, while in the others polyps or fibroids projecting into the cavity (n = 19) or a thick endometrium (n = 19) were suspected. On performing SISH the uterine cavity was found to be normal in 29 women, while 35 had suspected polyps/fibroids and 6 had other abnormalities. Hysteroscopy proved to be normal in 28 women, 35 had polyps/fibroids and 7 had other abnormalities. The sensitivity, specificity, positive and negative predictive values for TVS were 72.4%, 100%, 100% and 74%, respectively, while for SISH the corresponding figures were 91.4%, 92.6%, 89.3% and 94.1%. SISH is a simple, minimally invasive and cost-effective investigative tool enhancing the diagnostic accuracy of TVS and can be an effective screening test prior to hysteroscopy.

Sonohysterography versus transvaginal sonography for screening of patients with abnormal uterine bleeding

Objectives To compare the accuracy of saline infusion sonohysterography (SIS) with transvaginal sonography (TVS) for the screening of causes of abnormal uterine bleeding (AUB) in out-patients. Methods 81 patients with AUB were studied. All cases who were examined with TVS, were further investigated with SIS using saline as contrast medium, finally hysteroscopy was used as the gold standard. Results TVS had sensitivity of 72%, specificity of 92%, positive predictive value of 94% and negative predictive value of 65%, while SIS had sensitivity of 94.1%, specificity of 95%, positive predictive value of 96% and negative predictive value of 90%. TVS had kappa measure of agreement of 0.60 while 0.86 was reported for SIS. Conclusions In this study SIS was more sensitive and specific in diagnosing polyp, myoma and adenomyosis with high positive and negative predictive value. Furthermore, results obtained by SIS demonstrate more agreement with that obtained by hysteroscopy than TVS.

Accuracy of Saline Infusion Sonohysterography in Diagnosis of Uterine Intracavitary Pathology

Papers on Current Clinical and Basic Investigation: Poster Sessions Monday, April 30, 2001: Gynecology: PDF Only

Accuracy of saline infusion sonohysterography in diagnosis of uterine intracavitary pathology

Objective: To assess the accuracy of saline infusion sonohysterography versus transvaginal sonography in detecting intracavitary uterine pathology. Method: We reviewed ultrasonography reports of 29 patients who had undergone saline infusion sonohysterography for evaluation of the endometrial cavity. These patients were suspected of having uterine cavity pathology by transvaginal sonography. They underwent operative hysteroscopy or hysterectomy or both after sonohysterography. The findings at each stage were compared. We also assessed the reliability of transvaginal sonography in detecting intracavitary disease. Results: The findings were as follows: polyps were diagnosed in 23 patients and myoma in 2 patients; presence of intrauterine contraceptive device (IUD) was noted in 2 patients, and findings were normal in 2 patients. Polyps were accurately diagnosed in 21 (91.3%) of the patients. In two patients, there was a false diagnosis of polyps based on sonohysterography. The presence of intracavitary myoma and IUD were correctly diagnosed. Of two patients with normal sonohysterography, one had polyps diagnosed histopathologically. By simple transvaginal sonography, polyps were correctly diagnosed in only 8 (34%) of the patients. Intracavitary pathology could not be identified. Conclusion: Saline infusion sonohysterography is a simple, noninvasive procedure. Our study suggests that it is highly sensitive in diagnosing intracavitary uterine pathologies. Saline infusion sonohysterography can be beneficial in guiding the physician toward the selection of procedures that cause relatively less morbidity.