The Clinical Value of 3‐Dimensional Saline Infusion Sonography in Addition to 2‐Dimensional Saline Infusion Sonography in Women With Abnormal Uterine Bleeding

Abstract

Objective. To evaluate the clinical relevance of 3-dimensional saline infusion sonography (3D-SIS) in addition to conventional SIS in women with abnormal uterine bleeding suspected of having intrauterine abnormalities. Methods. All women suspected of having intrauterine abnormalities were eligible. Before 3D-SIS, conventional SIS was performed. The results of these techniques were compared with the "combined method reference standard" (hysteroscopy, endometrial sampling, and clinical followup in cases with normal SIS findings). Diagnostic characteristics (with 95% confidence intervals [CIs]) of 3D-SIS and SIS were calculated as well as their respective accuracy in evaluating the histologic nature, the intrauterine extension, and the location of intrauterine abnormalities. Moreover, the reliability (κ value) and clinical relevance of 3D-SIS were assessed. Results. A total of 49 women were included, and 4 women were excluded. The positive predictive values of 3D-SIS and SIS were, respectively, 1.00 and 0.86 (95% CI, 0.72-0.99; P = .15), and the diagnostic accuracy values were 0.98 (95% CI, 0.94-1.0) and 0.91 (95% CI, 0.83-0.99; P = .08). Saline infusion sonography and 3D-SIS were equally accurate in evaluating the histologic nature, intrauterine extent, and location of intrauterine abnormalities (respective κ values: 0.85 versus 0.93; P = .88; 0.83 versus 0.83; and 0.77 versus 0.80; P = .81). The reliability of 3D-SIS was good: intraobserver and interobserver agreement (κ) were 0.78 and 0.72. Three women (6.7%) had the benefit of additional 3D-SIS: in these women, SIS wrongly led to a diagnosis of intrauterine abnormalities (P = .08). Conclusions. Three-dimensional saline infusion sonography is valid and reliable in women suspected of having intrauterine abnormalities and may indeed have relevant clinical value in addition to conventional SIS.

Detection of endometrial pathology using saline infusion sonography versus gel instillation sonography: a prospective cohort study

“…This may be one of the reasons why gel instillation is associated with less procedurerelated pain compared with saline infusion. Promising results with three dimensional (3D) SIS in the evaluation of abnormal vaginal bleeding or uterine abnormalities have been published (10,11). Because a stable filling of the uterine cavity is mandatory for 3D-volume acquisition, 3D GIS is expected to allow for an equal or better 3D-image quality, without the necessity for a balloon catheter.…”

Comparison of 3‐dimensional with 2‐dimensional saline infusion sonohysterograms for the evaluation of intrauterine abnormalities

“…The sensitivity and specificity in this study for both 2DSIS and 3DSIS are overall consistent with the reported sensitivity and specificity for SIS in the literature. de Kroon et al 9 in a meta-analysis reported on pooled sensitivity of 95% for all pathology, 86% for polyps, and 87% for myomas and pooled specificity of 88% for all pathology, 81% for polyps, and 92% for myomas. The specificity in our study for endometrial polyps was 64% for 2DSIS and 75% for 3DSIS.…”

Gel instillation sonohysterography: first experience with a new technique

“…Recent publications have appeared about 3-dimensional sonohysterography with SIS (20,21). A more stable filling of the uterine cavity with gel allows a longer investigation time, which results in better 3-dimensional sonohysterographic images with fewer artifacts and moving tissue elements than with flushing saline.…”