AN EVALUATION OF SONOHYSTEROGRAPHY AND DIAGNOSTIC HYSTEROSCOPY FOR THE ASSESSMENT OF INTRAUTERINE PATHOLOGY

The availability of advanced hysteroscopic surgical techniques has cha nged the management of abnormal uterine bleeding. The aim of this stud y was to evaluate the use of transvaginal sonography (TVS), sonohyster ography (SH) and diagnostic hysteroscopy (DH) for the preoperative ass essment of the uterine cavity. The plan was to investigate 100 patient s with abnormal uterine bleeding despite conventional medical treatmen t. The endpoints were uterine abnormalities detected by operative hyst eroscopy and histology, and subjective estimates of discomfort during TVS and SH. A total of 104 patients (aged 26-79 years) were recruited and 98 (94%) underwent all three diagnostic procedures. Uterine abnorm alities were present in 52 patients (53%). There were 25 cases with at least one endometrial polyp, 17 with submucous fibroids, seven with e ndometrial hyperplasia and three with an adenocarcinoma. The overall s ensitivity of TVS improved after SH from 67 to 87% and the specificity from 89 to 91%. The positive predictive value increased from 88 to 92 % and the negative predictive value from 71 to 86%. The use of SH also improved the quality of information about the location and size of po lyps and submucous fibroids. Increased endometrial thickness associate d with adenocarcinoma was detected in all cases (three of three) by TV S and In four of seven cases of hyperplasia (five of seven cases after SH). Most patients reported minor discomfort during TVS or SH and no side-effects were apparent. The sensitivity of DH was 90% (92% for pol yps, 88% for fibroids); two cases with a polyp, two with a submucous f ibroid and one with endometrial hyperplasia were not detected. The use of aline infusion to enhance visualization of the endometrium increas es the diagnostic accuracy of transvaginal sonography to approach that of diagnostic hysteroscopy and also provides some additional informat ion. This development has implications for the management of uterine b leeding disorders.