Transvaginal ultrasonography sonohysterography and operative hysteroscopy for the evaluation of abnormal uterine bleeding

Objective. To evaluate the diagnostic accuracy of transvaginal ultrasonogra phy, sonohysterography and hysteroscopy in patients presenting with abnorma l uterine bleeding. Design. Prospective, blind, comparative study. Setting. Outpatient clinic and day surgery unit of a district hospital spec ializing in operative hysteroscopy. Patients. One hundred consecutive patients referred with abnormal uterine b leeding (AUB). Interventions. Transvaginal ultrasonography and sonohysterography were perf ormed in the outpatient clinic. Within 1 week, all patients underwent opera tive hysteroscopy. Main outcome measures. All diagnoses established by transvaginal ultrasonog raphy, and sonohysterography were compared to the appearance of the cavity using hysteroscopy as well as the histological diagnosis from removed tissu es. Results. In 88 patients information suitable for analysis was obtained by a ll methods. The detection rate of focal intrauterine pathology using sonohy sterography was (94.1%), but was significantly lower with transvaginal ultr asonography (23.5%). In about 75% of all cases none of the methods used was able to correctly detect endometrial hyperplasia. Conclusions. Sonohysterography was significantly better than transvaginal u ltrasonography in detecting focal intrauterine pathology. Visual examinatio n at operative hysteroscopy yielded no additional information to the detect ion or exclusion of focal lesions than was obtained at outpatient sonohyste rography. All methods performed equally in assessing endometrial pathology. We conclude that sonohysterography may replace diagnostic hysteroscopy in many patients with AUB.