P30.21: Saline infusion sonography in women presenting with post‐menopausal bleeding: positive predictive value and patient experience

Abstract

Objectives: Endometrial pathologies are common ultrasound findings in group of peri and postmenopausal women and are an indication for further diagnostics including biopsy, curettage, hysteroscopy. This study assessed whether a new elastography application with quantification possibility can differentiate normal and abnormal endometrium and to be a helpful tool to establish further management. Methods: The study included a group of 47 patients with endometrial thickness more than 5 mm. Elastographic images of the uterus were achived in all patient, due to pressure applied by operator of transvaginal probe. Mid-saggital view of endometrium was delineated and assessed, according to EITA scale and with the use of elastography index (EI). Subsequently pathological analysis was performed. Correlation between elastography indices, presented in numbers and pathologic results was analyzed. Results: Pathologies of endometrium (7 cases of carcinoma, 12 polyps, 5 hyperplasia) had higher elastography index -above 3. 22 out of 23 patients with normal and atrophic endometrium had EI less than 3. The values of EI for endometrial pathologies were in range from 3 to 8, the highest values were in hyperlasia and cancer. The corellation was significant, p < 0,0001.We did not find any changes in elastograms and EI, depending on the amount of pressure applied during examination. Conclusions: Quantification elastography proved to be helpful in differentiation between normal and pathological endometrium. Elastography could be an additional tool in planning further patient management. These results are in compliance with our previous study performed on different equipment.Supporting information can be found in the online version of this abstract AVM of the myometrium considered a rare entity. It is believed that acquired uterine AVM is fed from a solitary vessel while congenital lesions have many feeding vessels. We show by Doppler that some acquired uterine AVM alsow can be fed by multiple feeding vessel.Case presentations: Case 1: A 32 years old patient, G1P1, 2nd infertility.History of laparoscopic endometrioma cystectomy followed by IVF treatment, pregnancy and NSVD.repeated laparoscopic cystectomy for repeated giant endometrioma followed by two IVF reatment. Referred for routine Ultrasound evaluation 8 weeks post IVF treatment.The US revealed posterior wall hypo-echogenic mass with two jets flow. Color Doppler Ultrasound established the diagnosis of posterior wall AVM. The patient was treated with one selective embolization evaluated post treatment by Doppler Ultrasound. Case 2: A 37 years old patient, G3P2CS2A1, with delayed post abortion hemorrhage. Six weeks post D&C she presented to the emergency room with vaginal hemorrhage. Doppler ultrasound imaging established the diagnosis of an anterior wall uterine AVM.The patient was treated with two consecutive selective embolization evaluated by Doppler US. Conclusion: AVM of the uterus should be suspected in women presenting with vaginal hemorrhage, following abortion or delivery but...

Evaluation of the Efficacy of Saline Infusion Sonohysterography in Patients with Postmenopausal Bleeding

“…Similarly studies by Yildizhan et al and Dwivedi et al in postmenopausal women showed abnormality in 72% and 60% patients, respectively. 9,10 The sensitivity, specificity, PPV, and NPV of SIS in the detection of intrauterine abnormality in the present study was 96.2%, 71.4%, 92.9%, and 83.3%, respectively, while Kazandi et al's study showed sensitivity and specificity of SIS being 97%, 60%, 81%, and 93%, respectively, which was similar to the results of the present study. 11 While Bingol et al and Erdem et al studies showed sensitivity of 89.6% and 97.7% and specificity of 77.3% and 82.4%, respectively.…”

“…In the Ma and Dwivedi study, SIS diagnosed normal endometrium in 40%, endometrial polyps in 45%, thickened endometrium in 7.5%, and inconclusive findings in 7.5% of patients. 9 The postmenopausal group in the Yildizhan study showed polyps in 32.0%, submucosal fibroids in 24.0%, intramural fibroids in 8.0%, hyperplasia in 8.0%, and normal report in 28.0% patients. 10 In this study, abnormal findings on SIS were found in 28 patients (82.4%) while the remaining 6 patients (17.6%) showed no abnormality (thin/scanty endometrium).…”