SALINE SONOHYSTEROGRAPHY VALIDITY IN ABNORMAL UTERINE BLEEDING DURING THE REPRODUCTIVE AGE

SHAMDEEN, MAIDA; YOUSIF, ALAA

	SALINE SONOHYSTEROGRAPHY VALIDITY IN ABNORMAL UTERINE BLEEDING DURING THE REPRODUCTIVE AGE
Duhok Medical Journal
Article 1, Volume 10, Issue 1, 2016, Pages 1-1
Authors
MAIDA SHAMDEEN¹; ALAA YOUSIF²
¹Professor and chairman Obstetrics and Gynecology department, College of Medicine, University of Duhok
²Specialist obstetrician &gynecologist, College of Medicine, University of Duhok
Abstract
Background and objectives: To study the Sonohysterography accuracy and to compare results with the hysteroscopy and histological study. One of the tools for investigation in patients with Abnormal Uterine Bleeding (AUB), is Vaginal Ultra sound (VU/S), as an initial investigation. Saline Sono-Hysterography (SSHG), is more reliable for focal and generalized endometrial lesions. The technique was introduced in 1987 where by Installation of Isotonic Saline Solution into the cavity of the uterus was found to improve the endometrial cavity’s Transvaginal Sonographic imaging outcome. This study was conducted for the comparison of the accuracy of (VU/S), and (SSHG) as a first step in the diagnostic approach of endometrial abnormities of women presenting with (AUB), and to compare the results with hysteroscopy and histopathological findings. Patients and Methods: Ethical approval was properly taken. Patients were collected from Private and Azadi Teaching Hospital Consultation Clinics.A prospective study was started from June 1st. 2013 to March 1st. 2014 and conducted in 200 women in their reproductive years of age presented to Private and Azadi Teaching Hospital Consultation Clinics complaining from (AUB). All of them underwent (VU/S), and (SSHG) Transvaginal ultrasound, and Sonohysterography. Focal or generalized endometrial abnormalities were noticed, and classified into seven types (normal endometrium, thickened endometrium, endometrial hyperplasia, endometrial polyp, submucous myoma, uterine synechiae, andsuspesious ofmalignancy).Those women with positive findings then underwent hysteroscopy and diagnostic curettage, the histopathologic findings was compared with the results of (SSHG). Finally the correlation between sonographic results with definitive diagnoses that were obtained by hysteroscopy& endometrial biopsy was used to calculate the test predictive values. Results: The sensitivity and specificity of (SSHG) was 92.9% and 89.7% respectively, in contrast to the sensitivity and specificity of (VU/S) which was71.4% and 67.7% respectively. The (SSHG) and Hysteroscopy were 91% in agreement to each other while (VU/S) and Hysteroscopy were in agreement to each other in 69% of cases only, (p = 0.002).The diagnostic efficiency of (SSHG)in three main endometrial abnormalities (endometrial hyperplasia, polyps and sub mucous fibroids) were superior to that (VU/S). with the best results being seen in patients with sub mucous myoma where the level of both sensitivity and specificity reached 100% for (SSHG), this was in contrast to those of (VU/S) which reached 61.55 and 97.7% respectively. Conclusions: The results of our study have concluded that (SSHG) is a much better assessment tool than traditional (VU/S) in dealing with intrauterine lesions. Decision making in selecting cases for hysteroscopy and directed biopsy would be much better supported by having an accurate differentiation between focal and generalized endometrial abnormalities beforehand. Hence the use of (SSHG) as a first step in the diagnostic approach of (AUB) is strongly recommended by this study.
Keywords
Abnormal Uterine Bleeding; Vaginal Ultra sound; Saline Sono – Hysterography

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