title: Diagnostic accuracy of sonohysterography, hysterosalpingography and diagnostic hysteroscopy in diagnosis of arcuate, septate and bicornuate uterus.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of sonohysterography (SHG), hysterosalpingography (HSG) and diagnostic hysteroscopy (DH) in uterine anomaly detection and to assess the role of these various modalities in the differential diagnosis of arcuate, septate and bicornuate uteri.
  
  
  METHODS
  Eighty-three women, with a history of recurrent spontaneous abortions or infertility and initial diagnosis of uterine anomaly were included in the study. Diagnostic work-up comprised of SHG, HSG and DH. To assess the accuracy of these methods all the patients underwent hysterolaparoscopy to establish the final diagnosis. The correlation between the results of each method was evaluated and diagnostic accuracy of each method was assessed in the whole group of women as well as in subgroups of arcuate, septate and bicornuate uteri using receiver operator curve (ROC) method by estimating the area under the curve (AUC).
  
  
  RESULTS
  In the overall diagnosis of uterine anomalies, SHG with accuracy of 95.2% and correlation index of 0.873 (P < 0.001) proved to be a significantly better tool compared to DH (SHG(AUC) = 0.924 versus DH(AUC) = 0.761 P = 0.008), while no significant differences were observed between SHG versus HSG and DH versus HSG. SHG showed significantly higher accuracy (100.0%) compared to DH (80.7%) and HSG (80.7%) in differentiation of a septate (SHG(AUC) = 1.000 versus DH(AUC) = 0.816 P < 0.001 and SHG(AUC) = 1.000 versus HSG(ACC) = 0.818; P < 0.001) and bicornuate uterus (SGH(AUC) = 1.000 versus DH(ACC) = 0.707; P < 0.001 and SHG(ACC) = 1.000 versus HSG(AUC) = 0.790; P = 0.002).
  
  
  CONCLUSIONS
  SHG is a noninvasive, cost-effective method available in an outpatient setting that is highly accurate in identifying uterine anomalies, in particular septate and bicornuate uterus.
authors.affiliation: Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Ludwin
authors.forename: Inga
authors.initials: I
authors.lastname: Ludwin
authors.forename: Tomasz
authors.initials: T
authors.lastname: Banas
authors.forename: Anna
authors.initials: A
authors.lastname: Knafel
authors.forename: Margaret
authors.initials: M
authors.lastname: Miedzyblocki
authors.forename: Antoni
authors.initials: A
authors.lastname: Basta
mesh_terms: D000026:Abortion, Habitual / Q000209:etiology; D000328:Adult; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D015907:Hysteroscopy; D011247:Pregnancy; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014599:Uterus / Q000002:abnormalities* / Q000000981:diagnostic imaging