Transvaginal sonography combined with saline contrast sonohysterography inevaluating the uterine cavity in premenopausal patients with abnormal uterine bleeding

Objectives To evaluate whether saline contrast sonohysterography (SCSH) add s additional information to that obtained by transvaginal sonography (TVS) for predicting endometrial abnormality in premenopausal patients with abnor mal uterine bleeding. Patients and methods This was a two-center prospective study at a universit y clinic and a central hospital in Denmark. The uterine cavity was evaluate d with TVS and SCSH in 470 premenopausal patients with abnormal uterine ble eding. One hundred and eighty-nine of the patients had operative hysterosco py or hysterectomy within 4 months which provided a detailed description of the uterine cavity and was used as the true value for exclusion of polyps and submucous myomas. Results Based on normal endometrial morphology, alone, the results for dete ction of an abnormal uterine cavity, were as follows: sensitivities of TVS 0.92, SCSH 0.99; specificities of TVS 0.62, SCSH 0.72; positive predictive values of TVS 0.80, SCSH 0.85; negative predictive values of TVS 0.82, SCSH 0.98. Transvaginal sonography combined with SCSH was superior to TVS for d etection of intracavitary abnormalities (McNemar test, P = 0.008). The post -test probability of there being an abnormal cavity after normal findings o n TVS alone was 0.18 (0.10-0.32) and after TVS and SCSH it was 0.02 (0.01-0 .11). When normal endometrial morphology was combined with an endometrial t hickness of < 12 mm for evaluation of all abnormalities including hyperplas ia, the diagnostic potential of TVS or SCSH was almost unchanged except for specificities, which were markedly lower (TVS 0.54; SCSH 0.57). In all the patients referred, TVS had a negative predictive value of 0.94 for identif ication of polyps and myomas when findings at subsequent SCSH were accepted as the true value. Transvaginal sonography reduced the pretest probability of polyps or submucous myomas from 0.35 to a post-test probability of 0.06 , but missed 21 % of the polyps. Conclusions Sonohysterography was a sensitive tool and was superior to TVS used alone for evaluation of the uterine cavity inpatients who underwent op erative surgery for abnormal uterine bleeding. All abnormalities except one were found at SCSH, while TVS alone missed polyps and had almost one in fo ur equivocal findings. The use of TVS, without saline contrast, left one in five of the polyps undiagnosed in referred patients with abnormal bleeding .