Saline Infusion Sonohysterography versus Transvaginal Sonography in the Assessment of Postmenopausal Bleeding
Abstract
ABSTRACT
Background: Postmenopausal bleeding accounts for a significant proportion of gynecological referrals and occurs in approximately 3% of postmenopausal women. Approximately 10% of these postmenopausal bleedings have a gynecological malignancy.
Objectives: To assess the diagnostic accuracy of saline infusion sonohysterography and transvaginal ultrasound in the assessment of women with postmenopausal bleeding.
Methods: Forty eight women with postmenopausal bleeding were included in this caseseries study; they were collected from the Gynecological out-patient clinic in AL-Yarmuk teaching hospital, through the period from April 2009 to September 2010. They were subjected to transvaginal ultrasound and saline infusion sonohysterography at the same setting as part of the assessment. Each patient was further subjected to dilatation and curettage under general anesthesia on the next day to study the endometrial histology.
Results: The mean age of the patients included in the study was 56.7±9.12 years, their mean parity was 4.2±2.9, their mean duration of menopause was 7.3±7.2 years and their mean duration of bleeding was 16±25.7 days. Transvaginal ultrasound was abnormal in 40 cases (abnormal when endometrial thickness = 4 mm) with mean endometrial thickness (double layer) = 7.8±4.76 mm, saline infusion sonohysterography was abnormal in 32 cases (abnormal when endometrial thickness = 2.5 mm in the single layer and or in the presence of polyps), the mean endometrial thickness of the anterior layer = 3.2±2.0 mm and that of the posterior layer =3±1.72 mm, 14 cases of polyps were identified. The sensitivity of transvaginal ultrasound and saline infusion sonohysterography is 94.4%, 88.8%, respectively, and the specificity is 50%, 100%, respectively.
Conclusion: Saline infusion has proven to be more specific than transvaginal ultrasound in assessing postmenopausal bleeding and identifying intra-cavitary lesions but of comparable sensitivity.
Copyright (c) 2012 Iraqi Medical Journal
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