title: Diagnostic and clinical value of 3D gel installation sonohysterography in addition to 2D gel installation sonohysterography in the assessment of intrauterine abnormalities.
abstract: OBJECTIVE
  To study the diagnostic value of three-dimensional gel instillation sonography (3D GIS) in addition to two-dimensional (2D) GIS in the assessment of intrauterine abnormalities. Secondly, the clinical value of 3D GIS in the planning for hysteroscopic procedures was evaluated.
  
  
  METHODS
  A prospective cohort study was performed from 2008 till 2010. All women with a suspected intrauterine abnormality on 2D GIS suitable for hysteroscopic resection or with recurrent postmenstrual bleeding were planned for a hysteroscopic procedure. Diagnostic accuracy tests were calculated for the detection of fibroids and polyps with both histology and hysteroscopy as the reference standard. For the assessment of type and size of fibroids hysteroscopy was used as the reference standard. We compared the planning for type of hysteroscopy based on 2D GIS findings with the combined 2D-3D GIS findings.
  
  
  RESULTS
  In total 110 patients were analysed. In comparison to histology, addition of 3D GIS did not change sensitivity or specificity substantially in the discrimination between fibroids and polyps. In comparison to hysteroscopy, sensitivity increased for detecting fibroids and polyps, without major interference with the specificity. Despite an improved accuracy after the addition of 3D GIS, the planning for hysteroscopic procedures did not improve substantially.
  
  
  CONCLUSIONS
  In daily practice, the addition of 3D GIS to 2D GIS improved the accuracy for the detection of polyps and fibroids compared to hysteroscopy, but only marginally improved the planning of hysteroscopic procedures, and therefore the clinical relevance seems to be limited.
authors.affiliation: Department of Obstetrics and Gynaecology; VU University Medical Centre (VUmc), Amsterdam, The Netherlands. Electronic address: ll.nieuwenhuis@vumc.nl.
authors.forename: Lotte L
authors.initials: LL
authors.lastname: Nieuwenhuis
authors.affiliation: Department of Obstetrics and Gynaecology; VU University Medical Centre (VUmc), Amsterdam, The Netherlands.
authors.forename: Marjolein A J Bij
authors.initials: MA
authors.lastname: de Vaate
authors.affiliation: Department of Obstetrics and Gynaecology; VU University Medical Centre (VUmc), Amsterdam, The Netherlands.
authors.forename: Wouter J K
authors.initials: WJ
authors.lastname: Hehenkamp
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Centre (VUmc), Amsterdam, The Netherlands.
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Heymans
authors.affiliation: Department of Obstetrics and Gynaecology, Flevoziekenhuis, Almere, The Netherlands.
authors.forename: Marchien W M
authors.initials: MW
authors.lastname: van Baal
authors.affiliation: Department of Obstetrics and Gynaecology; VU University Medical Centre (VUmc), Amsterdam, The Netherlands.
authors.forename: Hans A M
authors.initials: HA
authors.lastname: Brölmann
authors.affiliation: Department of Obstetrics and Gynaecology; VU University Medical Centre (VUmc), Amsterdam, The Netherlands.
authors.forename: Judith A F
authors.initials: JA
authors.lastname: Huirne
mesh_terms: D000328:Adult; D005260:Female; D005782:Gels; D006801:Humans; D015907:Hysteroscopy; D021621:Imaging, Three-Dimensional; D007889:Leiomyoma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011127:Polyps / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging*
chemical_list: D005782:Gels
keywords: Abnormal uterine bleeding; Intra uterine abnormalities; Saline or gel infusion; Sonohysterography; Three dimensional