title: The clinical value of 3-dimensional saline infusion sonography in addition to 2-dimensional saline infusion sonography in women with abnormal uterine bleeding: work in progress.
abstract: OBJECTIVE
  To evaluate the clinical relevance of 3-dimensional saline infusion sonography (3D-SIS) in addition to conventional SIS in women with abnormal uterine bleeding suspected of having intrauterine abnormalities.
  
  
  METHODS
  All women suspected of having intrauterine abnormalities were eligible. Before 3D-SIS, conventional SIS was performed. The results of these techniques were compared with the "combined method reference standard" (hysteroscopy, endometrial sampling, and clinical follow-up in cases with normal SIS findings). Diagnostic characteristics (with 95% confidence intervals [CIs]) of 3D-SIS and SIS were calculated as well as their respective accuracy in evaluating the histologic nature, the intrauterine extension, and the location of intrauterine abnormalities. Moreover, the reliability (kappa value) and clinical relevance of 3D-SIS were assessed.
  
  
  RESULTS
  A total of 49 women were included, and 4 women were excluded. The positive predictive values of 3D-SIS and SIS were, respectively, 1.00 and 0.86 (95% CI, 0.72-0.99; P = .15), and the diagnostic accuracy values were 0.98 (95% CI, 0.94-1.0) and 0.91 (95% CI, 0.83-0.99; P = .08). Saline infusion sonography and 3D-SIS were equally accurate in evaluating the histologic nature, intrauterine extent, and location of intrauterine abnormalities (respective kappa values: 0.85 versus 0.93; P = .88; 0.83 versus 0.83; and 0.77 versus 0.80; P = .81). The reliability of 3D-SIS was good: intraobserver and interobserver agreement (kappa) were 0.78 and 0.72. Three women (6.7%) had the benefit of additional 3D-SIS: in these women, SIS wrongly led to a diagnosis of intrauterine abnormalities (P = .08).
  
  
  CONCLUSIONS
  Three-dimensional saline infusion sonography is valid and reliable in women suspected of having intrauterine abnormalities and may indeed have relevant clinical value in addition to conventional SIS.
authors.affiliation: Department of Gynecology, Leiden University Medical Center, K6-76, PO Box 9600, 2300 RC Leiden, the Netherlands.
authors.forename: Cornelis D
authors.initials: CD
authors.lastname: de Kroon
authors.forename: Leonie A
authors.initials: LA
authors.lastname: Louwé
authors.forename: J Baptist
authors.initials: JB
authors.lastname: Trimbos
authors.forename: Frank Willem
authors.initials: FW
authors.lastname: Jansen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007889:Leiomyoma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011127:Polyps / Q000000981:diagnostic imaging*; D017698:Postmenopause; D011237:Predictive Value of Tests; D017697:Premenopause; D011446:Prospective Studies; D015203:Reproducibility of Results; D012965:Sodium Chloride / Q000008:administration & dosage; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging*; D014599:Uterus / Q000000981:diagnostic imaging*
chemical_list: D012965:Sodium Chloride