title: Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium > 5 mm.
abstract: OBJECTIVE
  To determine the ability of transvaginal ultrasound, with or without saline infusion, to detect focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > 5 mm, and to determine the accuracy of conventional ultrasound, saline contrast sonohysterography and diagnostic hysteroscopy under general anesthesia to diagnose endometrial polyps, submucous myomas and uterine malignancy.
  
  
  METHODS
  In a prospective study, 105 women with postmenopausal bleeding and endometrium > 5 mm underwent conventional ultrasound examination and saline contrast sonohysterography. Diagnostic and operative hysteroscopy under general anesthesia was then performed. The presence of focally growing lesions and the type of lesion (endometrial polyp, submucous myoma, malignancy or unclear focal lesion) were noted at ultrasound examination and at hysteroscopy.
  
  
  RESULTS
  There was almost perfect agreement (96%) between saline contrast sonohysterography and hysteroscopy in the diagnosis of focally growing lesions. Saline contrast sonohysterography and hysteroscopy both had a sensitivity of approximately 80% with regard to diagnosing endometrial polyps (false-positive rates of 24% and 6%, respectively), whereas conventional ultrasound missed half of the polyps (sensitivity, 49%; false-positive rate, 19%). Hysteroscopy was superior to both saline contrast sonohysterography and conventional ultrasound with regard to discriminating between benign and malignant lesions (sensitivity, 84%, 44%, and 60%; false-positive rate, 15%, 6% and 10%, respectively). The risk of malignancy was increased seven-fold (odds ratio, 7.3; 95% confidence interval, 1.9-27.8) in women with distension difficulties at saline contrast sonohysterography, and two thirds of the women with a poorly distensible uterine cavity had a malignant diagnosis.
  
  
  CONCLUSIONS
  Saline contrast sonohysterography is as good as hysteroscopy at detecting focally growing lesions in the uterine cavity in women with postmenopausal bleeding. However, neither hysteroscopy nor saline contrast sonohysterography can reliably discriminate between benign and malignant focal lesions. Distension difficulties at saline contrast sonohysterography should raise a suspicion of malignancy.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Malmö, University of Lund, 205 02 Malmö, Sweden. elisabeth.epstein@obst.mas.lu.se
authors.forename: E
authors.initials: E
authors.lastname: Epstein
authors.forename: A
authors.initials: A
authors.lastname: Ramirez
authors.forename: L
authors.initials: L
authors.lastname: Skoog
authors.forename: L
authors.initials: L
authors.lastname: Valentin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004717:Endometrium / Q000000981:diagnostic imaging*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000601:surgery; D008599:Menstruation Disturbances / Q000000981:diagnostic imaging* / Q000601:surgery; D008875:Middle Aged; D011127:Polyps / Q000000981:diagnostic imaging / Q000601:surgery; D017698:Postmenopause; D012680:Sensitivity and Specificity; D012965:Sodium Chloride / Q000627:therapeutic use*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D014599:Uterus / Q000000981:diagnostic imaging*
chemical_list: D012965:Sodium Chloride