title: Detection of endometrial pathology using saline infusion sonography versus gel instillation sonography: a prospective cohort study.
abstract: OBJECTIVE
  To compare saline infusion sonography (SIS) with gel instillation sonography (GIS) in terms of feasibility and diagnostic accuracy.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Leuven University bleeding clinic.
  
  
  METHODS
  A total of 804 patients: two consecutive cohorts of 402 women undergoing SIS or GIS.
  
  
  METHODS
  Vaginal ultrasound (n=804) followed by SIS (n=402) or GIS (n=402); office hysteroscopy in 685 patients, and endometrium sampling in 487 patients; surgery in 274 women: operative hysteroscopy (n=230) or hysterectomy (n=44).
  
  
  METHODS
  Patients' characteristics, technical failure rates, and final diagnosis. Pathology was defined as endometrial hyperplasia, polyp, cancer, or intracavitary myomas.
  
  
  RESULTS
  The technical failure rate (difference between proportions and confidence interval) was 5.0% for SIS versus 1.8% for GIS, respectively (3.21; [0.69-5.95]). Failure due to inadequate distension was 1.5% versus 0.3% for SIS and GIS, respectively (1.25; [-0.16-2.99]). Pathology was diagnosed in 180 patients (49%) of the SIS group versus 147 patients of the GIS group (40.2%) (8.88; [1.69-15.95]). The sensitivity was 77.8% and 85.0%, respectively (NS). The negative predictive value was 79.1% for SIS and 88.6% for GIS (9.54; [2.17-16.89]).
  
  
  CONCLUSIONS
  Gel instillation sonography is a feasible, accurate alternative for SIS in the evaluation of women with abnormal bleeding, and has fewer technical failures.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals, and Department of Electrical Engineering, ESAT-SCD, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Erika
authors.initials: E
authors.lastname: Werbrouck
authors.forename: Joan
authors.initials: J
authors.lastname: Veldman
authors.forename: Jan
authors.initials: J
authors.lastname: Luts
authors.forename: Sabine
authors.initials: S
authors.lastname: Van Huffel
authors.forename: Dominique
authors.initials: D
authors.lastname: Van Schoubroeck
authors.forename: Dirk
authors.initials: D
authors.lastname: Timmerman
authors.forename: Thierry
authors.initials: T
authors.lastname: Van den Bosch
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging*; D004717:Endometrium / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D005782:Gels; D006801:Humans; D015907:Hysteroscopy; D007889:Leiomyoma / Q000000981:diagnostic imaging; D008875:Middle Aged; D011127:Polyps / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012965:Sodium Chloride; D014463:Ultrasonography / Q000379:methods* / Q000592:standards*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging
chemical_list: D005782:Gels; D012965:Sodium Chloride