A Comparative Observational Study of the Use of Saline Uterine Hydrosonography for the Diagnosis and Assessment of Uterine Cavity Lesions in Women

Abstract

Aim of this study was to evaluate the performance of saline hydrosonography (HSGM) (also known as saline infusion sonography (SIS)) against transvaginal ultrasound scan (TVS) and hysteroscopy in the diagnosis of uterine cavity lesions. Diagnostic hysteroscopy with biopsy is considered as the “gold standard” to diagnose intrauterine abnormalities. The introduction of HSGM has improved the diagnostic capability of ultrasound. It is important to establish the efficacy and safety of HSGM before it is widely recommended for use. This retrospective observational data was collected from all 223 patients who underwent TVS, HSGM, and hysteroscopy as part of their gynaecological investigations from 1 January 2008 to 31 December 2010 at Central Middlesex Hospital, London. Endometrial Polyps. TVS: sensitivity 60.53%, specificity 97.06%, positive predictive value (PPV) 95.83%, and negative predictive value (NPV) 68.75% and HSGM: sensitivity 95%, specificity 97.14%, PPV 97.44%, and NPV 94.44%. Submucous Leiomyoma. TVS: sensitivity 57.14%, specificity 93.48%, PPV 84.21%, and NPV 78.18% and HSGM: sensitivity 96.55%, specificity 100.00%, PPV 100.00%, and NPV 97.92%. Diagnostic efficacy of HSGM is superior to TVS for the diagnosis of endometrial polyps and submucous fibroids. HSGM should be considered as an intermediate investigation after TVS to assess intracavity pathology and to confirm the diagnosis; hysteroscopy should become a therapeutic intervention.

Usefulness of saline infusion sonohysterography and feeding artery imaging in endometrial polyp diagnosis

“…Our sensitivity of 75%, specificity of 100%, positive predictive value of 75%, and negative predictive value of 72% for saline infusion sonohysterography in diagnosing endometrial polyps are similar to those reported by other authors [6,[14][15][16][17]. The procedure is also much better tolerated compared to hysteroscopy [15,16].…”

Two‐dimensional transvaginal sonography vs saline contrast sonohysterography for diagnosing endometrial polyps: systematic review and meta‐analysis

“…Figure 2 shows the risk of bias and concerns regarding applicability in the included studies. For risk of bias and concerns regarding applicability, in the patient selection domain, one study 19 had an unclear risk of bias regarding patient inclusion criteria and five studies 21,23,29,32,35 were considered as having a high risk for bias since they excluded patients with ultrasonographic suspicion of endometrial cancer, uterine malformations, hormonal therapy, incomplete data or non-interpretable images.…”

Minimally Invasive Approaches to the Surgical Management of Fibroids

“…5,6 Saline-infused sonography can delineate submucosal fibroids from other intrauterine pathologies (such as endometrial polyps) and evaluate proximity of intramural fibroids from the endometrial cavity. 15,16 Three-dimensional (3D) ultrasonography allows for a clearer assessment of fibroid protrusion into the endometrial cavity as well as the thickness of the myometrium between the intramural portion of the mass and the serosa. 17 Lastly, magnetic resonance imaging (MRI) can be a useful tool in surgical planning to differentiate fibroids from adenomyomas, as well as reliably map out the number and size, vascularization patterns, and relationship of fibroids with the intrauterine cavity, serosal surface, and surrounding normal myometrium.…”