[Use of ultrasonography as a first-line investigation of the uterus. Results of a prospective study].
OBJECTIVE
To assess the effectiveness of hysterosonography as a first line investigation for uterine bleeding in perimenopausal women.


METHODS
185 women were enrolled in a prospective study. They underwent a hysterosonography indicated for abnormal uterine bleeding or follow-up of a treatment with tamoxifene. Patients with a normal cavity or atrophia were scheduled for a diagnostic hysteroscopy or a hormonal therapy. Patients with uterine cavity abnormalities were scheduled for surgery (operative hysteroscopy or hysterectomy). All the patients were clinically followed after the hysterosonography or the surgery. Results of hysterosonography were compared to data issued from the clinical follow-up or to pathological results when available.


RESULTS
Hysterosonography was achieved in 179 patients. In all but 1 case, hysterosonography was well tolerated by the patients. We had no complication during or after the examination. Hysterosonography had a high sensitivity and specificity in the discrimination of women with normal cavity or atrophia from the ones with intrauterine lesions (respectively 96.4% and 98.3%). Hysterosonography was also accurate in the distinction of polyps from sub-mucosal myomas (sensitivity 88.2 à 90.3%, specificity: 98.6 à 95%). The measurement and localization of the lesions were accurate in an equal manner with both procedures. Hysterosonography had similar results in women treated with tamoxifene, but the failure frequency was significantly higher (13% vs 1.8%) (p < 0.05).


CONCLUSIONS
Hysterosonography appears as a reliable tool for the investigation of abnormal uterine bleeding in perimenopausal women. It can distinguish women who just need a medical therapy from the ones who will require a surgical exploration. It is easy to learn, and well tolerated by the women. Hysterosonography is more sensitive and specific than transvaginal sonography in the follow-up of patients treated with Tamoxifene.
Bernard
J P
JP
Service de Gynécologie-Obstétrique, Hôpital Boucicaut, Paris.
Lecuru
F
F
Darles
C
C
Robin
F
F
De Bièvre
P
P
Taurelle
R
R
D000328:Adult; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy; D010535:Laparoscopy; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery
Utilisation de l'échographie avec accentuation de contraste comme examen de première intention dans l'exploration de la cavité utérine. Résultats d'une enquête prospective.