Comparison of transvaginal sonography, saline infusion sonography, and hysteroscopy in premenopausal women with abnormal uterine bleeding

Purpose. Saline infusion sonography (SIS) is a relatively new technique in the evaluation of abnormal uterine bleeding. We compared the diagnostic acc uracy of SIS with that of transvaginal sonography (NS) in the detection of intracavitary abnormalities in premenopausal women with abnormal uterine bl eeding. Methods. In this prospective study, consecutive premenopausal women who und erwent a hysteroscopy for abnormal uterine bleeding also underwent TVS and SIS. The findings at TVS and SIS were compared with the hysteroscopic and h istologic findings, Sensitivity, specificity, and likelihood ratios were ca lculated. Receiver operating characteristic curves were constructed to asse ss the performance of endometrial thickness measured using TVS. Results. Sixty-two patients were included in the study, TVS demonstrated 60 % sensitivity in directly visualizing intracavitary abnormalities and 93% s pecificity. The likelihood ratio of the presence of an intracavitary abnorm ality was 8, and the likelihood ratio of the absence of an intracavitary ab normality was 0.43. Defining an abnormality at TVS as direct visualization of an intracavitary abnormality or an endometrial thickness greater than 5 mm, TVS had an 85% sensitivity and a 21% specificity, with corresponding li kelihood ratios of 1.1 and 0.71, respectively. For SIS, the sensitivity, sp ecificity, and likelihood ratios of the presence and absence of intracavita ry abnormalities were 88%, 95%, 10, and 0.13, respectively. Conclusions. SIS is more accurate in the diagnosis of intracavitary abnorma lities in premenopausal women than is TVS. An approach using endometrial th ickness measurement by TVS and reserving SIS for patients who have an endom etrial thickness greater than 5 mm or an intracavitary abnormality visualiz ed by TVS would be the most effective method to reduce the number of hyster oscopies. (C) 2000 John Wiley & Sons, Inc.