title: Transvaginal sonography versus hysteroscopy in evaluation of abnormal uterine bleeding.
abstract: BACKGROUND
  Abnormal uterine bleeding (AUB) accounts for 33% of female patients referred to gynaecologists. Common causes of AUB include endometrial polyps, endometrial hyperplasia, submucous fibroids and anovulation. Accurate diagnosis of the cause of AUB can reduce the frequency of hysterectomy. This study was aimed at assessing the usefulness of TVS in comparison with hysteroscopy in AUB evaluation.
  
  
  METHODS
  100 female patients with AUB were enrolled in the study. Each patient was subjected to TVS where uterine cavity was studied in detail and hysteroscopy under anaesthesia using saline as distension medium. Sensitivity, specificity and predictive value of TVS as compared to hysteroscopy were calculated. Subgroup analysis within each group was also performed.
  
  
  RESULTS
  Menorrhagia was the commonest presenting symptom in the study population (n = 58) followed by metrorrhagia, menometrorrhagia and continuous bleeding >21 days. 74 female patients had normal size uterus. In 57 patients, the uterine cavity was normal on TVS. Thickened endometrium, endometrial polyp and submucous fibroids were seen in 19, 16 and 6 patients respectively. Hysteroscopy showed normal cavity in 59 female patients and polypoidal endometrium, polyps or submucous fibroids in 41. TVS was found to have high sensitivity and specificity (95.23 and 94.82 respectively) and high positive and negative predictive value. Strength of agreement between TVS and hysteroscopy was high (kappa value 0.898).
  
  
  CONCLUSIONS
  TVS is recommended as first line investigation in AUB. If TVS shows normal cavity, further evaluation can be omitted and patient started directly on medical treatment for her symptoms.
authors: Senior Adviser (Obst-Gynae & Gynae Onco), Command Hospital (West Command), Chandimandir, India.
authors: B K
authors: BK
authors: Goyal
authors: Medical Officer (Obst-Gynae), Base Hospital, Delhi Cantt 10, India.
authors: Indu
authors: I
authors: Gaur
authors: Classified Specialist (Obst-Gynae), Naval Hospital, Powai, Mumbai, India.
authors: Sunil
authors: S
authors: Sharma
authors: Graded Specialist (Obst-Gynae), 159 Gen Hospital, C/O 56 APO, India.
authors: Arunabha
authors: A
authors: Saha
authors: Classified Specialist (Obst-Gynae), Command Hospital (Eastern Command), Kolkata 700027, India.
authors: N K
authors: NK
authors: Das
keywords: Abnormal uterine bleeding; Endometrial polyp; Hysteroscopy; Submucous fibroid; Transvaginal sonography