Comparison of transvaginal sonography and saline infusion sonohysterography for the diagnosis of causes of abnormal uterine bleeding: a diagnostic accuracy study

Background: Abnormal uterine bleeding (AUB) is one of the frequently observed gynecological problems in outpatient settings. Diagnosis of the cause of AUB is important and hysteroscopy with biopsy is considered is best method for diagnosis of the same. Recent studies suggest the role of transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) for the diagnosis of AUB though data about accuracy and comparison of these techniques with gold standard is not available. The study was designed with the aim of comparison of TVS and SIS for the diagnosis of abnormal uterine bleeding in reference to microscopical examination after hysterectomy.Methods: 100 consecutive patients of AUB were included in the study on the basis of inclusion and exclusion criteria. TVS and SIS were performed on each patient before the surgery for hysterectomy. The findings of TVS and SIS were compared with microscopical examination of the specimen after the hysterectomy. Sensitivity, specificity, positive predictive and negative predictive values were measured.Results: For sub mucosal myoma sensitivity , specificity, positive predictive value, negative predictive value and kappa statistics of SIS were 100%, 100%, 100%, 100%, 1 respectively while for TVS It were 18.1%, 98.8%, 66.6%, 90.7% and 0.25 respectively.Conclusions: SIS has superior diagnostic accuracy and compared to TVS. These findings need to be confirmed by randomized studies with more sample size