title: Comparison of saline infusion sonohysterography and hysteroscopy in diagnosis of premenopausal women with abnormal uterine bleeding.
abstract: OBJECTIVE
  The aim of this study was to compare the diagnostic effectiveness of transvaginal sonography (TVS), saline infusion sonohysterography (SIS), and diagnostic hysteroscopy (HS), with the pathologic specimen as a gold standard diagnostic method, in detecting endometrial pathology in premenopausal women with abnormal uterine bleeding.
  
  
  METHODS
  This prospective cohort study was conducted at Zeynep Kamil Education and Training Hospital, Istanbul, Turkey, and included 89 premenopausal women. All participants were examined first by TVS, further investigated with SIS and HS, and finally dilatation and curettage was performed when needed. The results obtained from these three methods were compared with the pathologic diagnoses. The positive and negative likelihood ratios (LR+ and LR-) of TVS, SIS and HS were calculated by comparison with the final pathological diagnosis. In addition, area under the curve (AUC) values were also calculated.
  
  
  RESULTS
  Polypoid lesion was the most common abnormal pathology. LR+ and LR- of TVS, SIS, and HS were 3.13 and 0.15, 9.83 and 0.07, 13.7 and 0.02 respectively in detection of any abnormal pathology, and the AUCs of TVS, SIS, and HS were 0.804, 0.920, and 0.954 respectively. When the three procedures were compared with each other separately, HS had the best diagnostic accuracy, and the diagnostic accuracy of HS and SIS was superior to TVS (p(1)=0.000, p(2)=0.000). For the detection of polypoid lesions, HS was the most accurate diagnostic procedure (AUC=0.947), followed by SIS (AUC=0.894) and TVS (AUC=0.778).
  
  
  CONCLUSIONS
  HS provides the most accurate diagnosis and allows treatment in the same session in premenopausal women with abnormal uterine bleeding.
authors.affiliation: Zeynep Kamil Training and Education Hospital, Istanbul, Turkey.
authors.forename: Suna
authors.initials: S
authors.lastname: Soguktas
authors.forename: Ebru
authors.initials: E
authors.lastname: Cogendez
authors.forename: Semra Eser
authors.initials: SE
authors.lastname: Kayatas
authors.forename: Mehmet Resit
authors.initials: MR
authors.lastname: Asoglu
authors.forename: Selcuk
authors.initials: S
authors.lastname: Selcuk
authors.forename: Aktug
authors.initials: A
authors.lastname: Ertekin
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015331:Cohort Studies; D004107:Dilatation and Curettage; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis / Q000473:pathology; D017697:Premenopause; D011446:Prospective Studies; D012965:Sodium Chloride; D014463:Ultrasonography; D014591:Uterine Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D014592:Uterine Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D014599:Uterus / Q000000981:diagnostic imaging*
chemical_list: D012965:Sodium Chloride