title: Comparison of hydrosonography and transvaginal ultrasonography in the detection of intracavitary pathologies in women with abnormal uterine bleeding.
abstract: BACKGROUND
  The aim of the study was to compare the accuracy of hydrosonography with that of transvaginal ultrasonography in detection of intracavitary pathologies in patients with history of abnormal uterine bleeding.
  
  
  METHODS
  Prospective, randomized, and unblinded study.
  
  
  METHODS
  A total of 197 women (n = 130 premenopausal and n = 67 postmenopausal) aged between 23 and 71 years (mean age 45.7 +/- 8.9) presenting with a history of abnormal uterine bleeding were included into the study. Hydrosonography was carried out by experienced gynecologists, on the same setting in an outpatient clinic immediately after the performance of transvaginal sonography. The finally obtained surgical-pathologic findings were compared with the results obtained from transvaginal sonography and hydrosonography. Sensitivity, specificity, positive, and negative predictive values were calculated for each procedure.
  
  
  RESULTS
  The surgical-pathologic examination confirmed normal physiologic endometrium in 50 (48%) of 104 women who were said to have normal endometrium on transvaginal sonography. Seventy (75%) of 93 women diagnosed of intracavitary pathologies on transvaginal sonography were confirmed by surgical-pathologic findings. The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal sonography in the detection of intracavitary pathology were 56, 68, 75, and 48%, respectively. Surgical-pathologic results revealed intracavitary pathologies in 23 (30%) of 76 women who were said to have normal endometrium on hydrosonography. Among 121 women diagnosed of intracavitary pathologies on hydrosonography, 101 (81%) women were confirmed after histological evaluation of the surgical specimens. The sensitivity, specificity, positive predictive value, and negative predictive value of hydrosonography in the detection of intracavitary pathology were 81, 73, 83, and 70%, respectively. Sensitivity and negative predictive value were significantly higher with hydrosonography. There were five cases of endometrial malignancy in which one of the case of malignancy was on polyp and two cases of endometrial hyperplasia with atypia which were not stated on sonographic results.
  
  
  CONCLUSIONS
  Hydrosonography is more accurate than transvaginal ultrasography in the detection of intracavitary pathologies in women with abnormal uterine bleeding.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.
authors.forename: M A
authors.initials: MA
authors.lastname: Guven
authors.forename: T
authors.initials: T
authors.lastname: Bese
authors.forename: F
authors.initials: F
authors.lastname: Demirkiran
mesh_terms: D000328:Adult; D000368:Aged; D016889:Endometrial Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D004715:Endometriosis / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008875:Middle Aged; D011127:Polyps / Q000150:complications / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods / Q000592:standards; D014592:Uterine Hemorrhage / Q000209:etiology*