Comparison of Transvaginal Scans with Saline Infusion Hysterography in Cases of AUB

Abstract

Introduction: The various etiologies  of AUB  are submucosal fibroids, endometrial polyps, and endometrial hyperplasia .In abnormal uterine bleeding [ AUB] the screening modality is ultrasound mainly transvaginal scans.The  diagnostic gold standard in these cases of AUB is hysteroscopy which being an operative modality is invasive ^. Keeping this aimin mind this prospective study was done to compare  saline infusion sonohysterography [ SIS)  with diagnostic hysteroscopy (DH) for the diagnosis of endometrial pathology in patients with abnormal uterine bleeding.

Aims  and Objectives: Comparison of TRANSNAGINAL SCANS with saline infusion hysterography in cases of AUB .

Material  and Methods :100 patients with AUB underwent TVS ,SIS and hysteroscopy .TVS ,3D SIS and DH was done on  day 5 to day 10 of menstrual cycle .Findings elucidated on TVS, SIS, hysteroscopy were compared and their statistical significance calculated ,

Results : Out of 100 patients with abnormal uterine bleeding, On TVS 53 %were normal .28%  had endometrial hyperplasia 10%  had polyp ,9% had myoma , On SIS  55% were normal 20% endometrial hyperplasia ,10% had polyp 13 % had myoma  and 2 % had adhesions ,On DH  55% were normal 16% endometrial hyperplasia ,16% had polyp 13 % had myoma  .1%  had endometrial carcinoma and 2 % had adhesions .SIS was more sensitive and specific in comparison to TVS .The sensitivity and specificity of TVS  were   71.4 %  and 67.75 resp compared to  92.9 % sensitivity and 89.7%specificity of SIS .Positive predictive value of SIS was 86.7 % as compared to 54.4% for TVS .Diagnostic accuracy of SIS -91 %  was significantly more than TVS –[69%] with a p value =0.002.

Conclusion : Hysteroscopy is the diagnostic gold standard .Even though hysteroscopy  has the advantage of being a curative modality also it has a limitation as it is invasive .SIS is a noninvasive new  diagnostic modality with improved sensitivity and specificity .It is safe .Hence its use is recommended in all cases of AUB. However larger RCT s are required

Keyword: SIS (saline infusion  sonohysterography), AUB (abnormal uterine bleeding), DUB (Dysfunctional uterine bleeding), TVS (Transvaginal sonography)