Value of 3-dimensional sonohysterography for detection of intrauterine lesions in women with abnormal uterine bleeding.
OBJECTIVE
To compare 2-dimensional (2D) sonohysterography (SHG) and 3D-SHG with saline solution infusion vs diagnostic hysteroscopy for investigation of intrauterine lesions in perimenopausal and postmenopausal women with abnormal uterine bleeding.


METHODS
Comparative observational cross-sectional study (Canadian Task Force classification II-1).


METHODS
University hospital.


METHODS
Fifty perimenopausal and 20 postmenopausal women with abnormal intrauterine bleeding with clinically or ultrasonically suspected intrauterine lesions.


METHODS
Conventional 2D- and 3D ultrasonography and 2D- and 3D-SHG with saline solution infusion followed by diagnostic hysteroscopy, and endometrial curettage or subsequent operative treatment (e.g., hysterectomy, myomectomy, or polypectomy). Ultrasonographic and hysteroscopic findings were compared with histopathologic findings.


RESULTS
For 2D-SHG, sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, likelihood ratio for a positive result, and likelihood ratio for a negative result were 79%, 72%, 89%, 54%, 76%, 2.82, and 0.29, respectively, and for 3D-SHG, were 92%, 89%, 96%, 80%, 91%, 8.36, and 0.09, respectively; and for diagnostic hysteroscopy, were 94%, 89%, 96%, 84%, 93%, 8.55, and 0.07, respectively. Thus, 3D-SHG was superior to 2D SHG (p = .02) and comparable to diagnostic hysteroscopy (p = .75) for diagnosis of intrauterine lesions.


CONCLUSIONS
3D-SHG can be used in the initial investigation of intrauterine lesions in perimenopausal and postmenopausal women with abnormal uterine bleeding before resorting to invasive procedures such as diagnostic hysteroscopy. Further studies of computer-reconstructed 3D-SHG virtual hysteroscopy are recommended.
Department of Obstetrics and Gynaecology, Cairo University Faculty of Medicine, Cairo, Egypt.
Nermeen
N
Abou-Salem
Akmal
A
Elmazny
Walid
W
El-Sherbiny
D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D019160:Endosonography; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012462:Saline Solution, Hypertonic; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy
D012462:Saline Solution, Hypertonic