Transvaginal saline hysterosonography: Characteristics distinguishing malignant and various benign conditions

OBJECTIVE, The objective of this study is to establish criteria for disting uishing endometrial polyps, submucosal leiomyomas, endometrial hyperplasia, and endometrial carcinoma on saline hysterosonography. MATERIALS AND METHODS. Sixty-three saline hysterosonograms with histologic confirmation were retrospectively analyzed. We found 26 endometrial polyps, 16 submucosal leiomyomas, three endometrial hyperplasias, one abnormal end ometrium associated with a sloughed polyp, one pseudopolyp, and three endom etrial carcinomas; 15 sonograms revealed no abnormality. In two patients, s onography revealed both polyps and submucosal leiomyomas. The sonographic a ppearance of these abnormalities was analyzed to define criteria for their diagnosis. RESULTS. Twenty-five of 26 polyps were uniformly echogenic with smooth bord ers and either had a stalk or formed acute angles with underlying endometri um. Sixteen of 16 submucosal leiomyomas showed heterogeneous echogenicity; however, 13 were sessile and three were pedunculated. Endometrial hyperplas ia was manifested by wall thickening in two patients and tiny polypoid excr escences in one patient. In all patients with endometrial carcinoma, the en dometrial cavities were poorly distensible despite successful cervical os c annulation. All patients with abnormalities other than endometrial carcinom a had fully distensible uterine cavities. CONCLUSION. Malignant and various benign endometrial conditions may be accu rately distinguished on saline hysterosonography. Uniformity of echogenicit y distinguished all polyps from submucosal leiomyomas, but the angulation f ormed with the endometrial wall by the intracavitary mass did not distingui sh all polyps from submucosal leiomyomas. Lack of distensibility of the end ometrial canal is a potential sign of endometrial carcinoma.