Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases.
OBJECTIVE
To evaluate the diagnostic accuracy of sonohysterography (SHG) in uterine cavity diseases in infertile patients, comparing its results with those of hysterosalpingography (HSG) and transvaginal sonography (TVS). Hysteroscopy was the gold standard.


METHODS
Descriptive, prospective study.


METHODS
A tertiary university referral center.


METHODS
Sixty-five infertile women 19 to 43 years of age.


METHODS
Patients underwent SHG, conventional TVS, HSG, and hysteroscopy.


METHODS
The results of each examination were compared with those obtained by the gold standard. The following diagnoses were considered separately: polypoid lesions, uterine malformations, intrauterine adhesions, and endometrial hyperplasia (EH). Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and 95% confidence intervals were calculated.


RESULTS
Sonohysterography had the same diagnostic accuracy as the gold standard for polypoid lesions and EH, with no equivocal diagnosis. Hysterosalpingography showed a sensitivity of 50% and a PPV of 28.6% for polypoid lesions and a sensitivity of 0% for EH. Transvaginal sonography had both sensitivity and PPV of 75% for polypoid lesions and EH. For uterine malformations, SHG had a sensitivity of 77.8%, whereas TVS and HSG both had a sensitivity of 44.4%. Sonohysterography and HSG had a sensitivity of 75% in the detection of intrauterine adhesions and respective PPVs of 42.9% and 50%. Transvaginal sonography showed sensitivity and PPV of 0% for this diagnosis.


CONCLUSIONS
Sonohysterography was in general the most accurate test. Its diagnostic accuracy was markedly superior for polypoid lesions and EH, with total agreement with the gold standard. In diagnosis of intrauterine adhesions, SHG had limited accuracy, similar to that obtained by HSG, with a high false-positive diagnosis rate.
Soares
S R
SR
Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Alfredo Balena, Belo Horizonte, Brazil. ikbg2@cc.uab.es
Barbosa dos Reis
M M
MM
Camargos
A F
AF
D000328:Adult; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000009:adverse effects / Q000379:methods*; D015907:Hysteroscopy / Q000379:methods; D007247:Infertility, Female / Q000000981:diagnostic imaging; D011127:Polyps / Q000000981:diagnostic imaging; D011446:Prospective Studies; D000267:Tissue Adhesions; D014463:Ultrasonography / Q000379:methods; D014591:Uterine Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging; D014599:Uterus / Q000002:abnormalities / Q000473:pathology; D014621:Vagina / Q000000981:diagnostic imaging