title: Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding: systematic review and meta-analysis.
abstract: OBJECTIVE
  To analyze the diagnostic accuracy of two- (2D) and three- (3D) dimensional saline contrast sonohysterography (SCSH) in the detection of endometrial polyps and submucosal uterine leiomyomas in women of reproductive age with abnormal uterine bleeding compared with gold standard hysteroscopy.
  
  
  METHODS
  A systematic review of diagnostic studies that compared 2D- and/or 3D-SCSH with hysteroscopy and anatomopathology was conducted according to PRISMA and SEDATE recommendations. The databases MEDLINE, EMBASE and The Cochrane Library were searched electronically using specific terms with no restriction on language or publication year. Quality assessment of included studies was performed using the QUADAS-2 tool. Meta-analysis was performed with the Meta-DiSk program and data presented as forest plots and summary receiver-operating characteristics (SROC) curves. Pooled sensitivity, specificity and positive (LR+) and negative (LR-) likelihood ratios of SCSH in the detection of uterine cavity abnormalities were calculated.
  
  
  RESULTS
  A total of 1398 citations were identified and five studies were included in the systematic review and meta-analysis. Pooled sensitivity and specificity of 2D-SCSH in detecting endometrial polyps were 93% (95% CI, 89-96%) and 81% (95% CI, 76-86%), respectively, with pooled LR+ of 5.41 (95% CI, 2.60-11.28) and LR- of 0.10 (95% CI, 0.06-0.17). In the detection of submucosal uterine leiomyomas, pooled sensitivity and specificity were 94% (95% CI, 89-97%) and 81% (95% CI, 76-86%), respectively, with pooled LR+ of 4.25 (95% CI, 2.20-8.21) and LR- of 0.11 (95% CI, 0.05-0.22). 2D-SCSH had good accuracy in detecting endometrial polyps and submucosal uterine leiomyomas, with areas under the SROC curves of 0.97 ± 0.02 and 0.97 ± 0.03, respectively. Studies that analyzed the diagnostic accuracy of 3D-SCSH could not be compared due to high heterogeneity related to menopausal status, type of technique used and primary outcome being investigation of infertility.
  
  
  CONCLUSIONS
  2D-SCSH proved to be a highly sensitive method for detection of endometrial polyps and submucosal uterine leiomyomas, making it a potential first-line diagnostic method in the work-up for women with abnormal uterine bleeding. More studies are needed on 3D-SCSH in women of reproductive age. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: C A
authors.initials: CA
authors.lastname: Bittencourt
authors.affiliation: Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Dos Santos Simões
authors.affiliation: Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: W M
authors.initials: WM
authors.lastname: Bernardo
authors.affiliation: Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: L F P
authors.initials: LFP
authors.lastname: Fuchs
authors.affiliation: Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: J M
authors.initials: JM
authors.lastname: Soares Júnior
authors.affiliation: Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: A R
authors.initials: AR
authors.lastname: Pastore
authors.affiliation: Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: E C
authors.initials: EC
authors.lastname: Baracat
mesh_terms: D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007889:Leiomyoma / Q000150:complications / Q000000981:diagnostic imaging*; D011127:Polyps / Q000150:complications / Q000000981:diagnostic imaging*; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D012965:Sodium Chloride / Q000008:administration & dosage; D014592:Uterine Hemorrhage / Q000209:etiology; D014594:Uterine Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride
keywords: abnormal uterine bleeding; hysteroscopy; saline infusion sonography; ultrasonography; uterus