Role of saline infusion sonohysterography in abnormal uterine bleeding: a hospital-based observational study.
DOI:
https://doi.org/10.51168/dh237t03Keywords:
abnormal uterine bleeding, saline infusion sonohysterography, transvaginal sonography, endometrial polyp, submucous fibroid.Abstract
Introduction
Abnormal uterine bleeding is a common gynaecological complaint, particularly among perimenopausal and postmenopausal women. Focal intracavitary lesions such as endometrial polyps and submucosal fibroids may be difficult to characterize on transvaginal sonography. Saline infusion sonohysterography improves delineation of the endometrial cavity and may enhance diagnostic assessment.
Materials and Methods
A hospital-based observational study was conducted among 50 perimenopausal and postmenopausal women presenting with abnormal uterine bleeding. Participants underwent clinical evaluation, transvaginal sonography and saline infusion sonohysterography. Women with suspected intracavitary lesions or increased endometrial thickness underwent appropriate definitive procedures, including dilatation and curettage, hysteroscopy-guided biopsy or polypectomy, or hysterectomy. Histopathological examination was used as the reference standard.
Results
Among 50 women, 33 (66.0%) were perimenopausal and 17 (34.0%) were postmenopausal, with a mean age of 49.9 ± 9.08 years. Menorrhagia was the most common symptom (48.0%). Transvaginal sonography showed polypoidal thickening in 26 (52.0%), while saline infusion sonohysterography identified endometrial polyps in 31 (62.0%) and submucous fibroids in 8 (16.0%). Histopathology demonstrated endometrial polyps in 31 (62.0%), endometrial hyperplasia in 10 (20.0%), fibroid uterus in 5 (10.0%), and normal endometrium in 4 (8.0%). The association between saline infusion sonohysterography and histopathological diagnosis was significant (p<0.001). Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 83.0%, 100.0%, 100.0%, 27.27% and 84.0%, respectively.
Conclusion
Saline infusion sonohysterography demonstrated good diagnostic performance for intracavitary lesions in women with abnormal uterine bleeding and is a useful complementary investigation following transvaginal sonography.
Recommendations
Saline infusion sonohysterography should be considered when transvaginal sonography demonstrates endometrial thickening or suspected intracavitary pathology.
References
1. Talukdar B, Mahela S. Abnormal uterine bleeding in perimenopausal women: Correlation with sonographic findings and histopathological examination of hysterectomy specimens. J Midlife Health. 2016 Apr-Jun;7(2):73-7. doi: 10.4103/0976-7800.185336. PMID: 27499594; PMCID: PMC4960944.https://doi.org/10.4103/0976-7800.185336
2. Matthews ML. Abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol Clin North Am. 2015 Mar;42(1):103-15. doi: 10.1016/j.ogc.2014.09.006. Epub 2014 Dec 5. PMID: 25681843.
https://doi.org/10.1016/j.ogc.2014.09.006
3. Vitale SG, Watrowski R, Barra F, D'Alterio MN, Carugno J, Sathyapalan T, Kahramanoglu I, Reyes-Muñoz E, Lin LT, Urman B, Ferrero S, Angioni S. Abnormal Uterine Bleeding in Perimenopausal Women: The Role of Hysteroscopy and Its Impact on Quality of Life and Sexuality. Diagnostics (Basel). 2022 May 9;12(5):1176. doi: 10.3390/diagnostics12051176. PMID: 35626331; PMCID: PMC9140476.https://doi.org/10.3390/diagnostics12051176
4. Shokouhi B. Role of transvaginal ultrasonography in diagnosing endometrial hyperplasia in pre- and post-menopause women. Niger Med J. 2015 Sep-Oct;56(5):353-6. doi: 10.4103/0300-1652.170390. PMID: 26778888; PMCID: PMC4698852.
https://doi.org/10.4103/0300-1652.170390
5. Niknejadi M, Haghighi H, Ahmadi F, Niknejad F, Chehrazi M, Vosough A, Moenian D. Diagnostic accuracy of transvaginal sonography in the detection of uterine abnormalities in infertile women. Iran J Radiol. 2012 Sep;9(3):139-44. doi: 10.5812/iranjradiol.8063. Epub 2012 Sep 17. PMID: 23329979; PMCID: PMC3522369.https://doi.org/10.5812/iranjradiol.8063
6. Van den Bosch T. Ultrasound in the diagnosis of endometrial and intracavitary pathology: an update. Australas J Ultrasound Med. 2012 Feb;15(1):7-12. doi: 10.1002/j.2205-0140.2012.tb00135.x. Epub 2015 Dec 31. PMID: 28191132; PMCID: PMC5025133.https://doi.org/10.1002/j.2205-0140.2012.tb00135.x
7. Kumar K, Pajai S, Baidya GR, Majhi K. Utility of Saline Infusion Sonohysterography in Gynecology: A Review Article. Cureus. 2023 Feb 24;15(2):e35424. doi: 10.7759/cureus.35424. PMID: 36987479; PMCID: PMC10040238.
https://doi.org/10.7759/cureus.35424
8. Sabry ASA, Fadl SA, Szmigielski W, Alobaidely A, Ahmed SSH, Sherif H, R H Yousef R, Mahfouz A. Diagnostic value of three-dimensional saline infusion sonohysterography in the evaluation of the uterus and uterine cavity lesions. Pol J Radiol. 2018 Nov 30;83:e482-e490. doi: 10.5114/pjr.2018.80132. PMID: 30655928; PMCID: PMC6334128.
https://doi.org/10.5114/pjr.2018.80132
9. Moradan S, Darzi SN, Ghorbani R. Diagnostic value of saline infusion sonohysterography for detecting endometrial focal lesion. Pan Afr Med J. 2019 Jul 16;33:211. doi: 10.11604/pamj.2019.33.211.16563. PMID: 31693718; PMCID: PMC6814347.
https://doi.org/10.11604/pamj.2019.33.211.16563
10. Alshdaifat EH, El-Deen Al-Horani SS, Al-Sous MM, Al-Horani S, Sahawneh FE, Sindiani AM. Histopathological pattern of endometrial biopsies in patients with abnormal uterine bleeding in a tertiary referral hospital in Jordan. Ann Saudi Med. 2022 May-Jun;42(3):204-213. doi: 10.5144/0256-4947.2022.204. Epub 2022 Jun 2. PMID: 35658582; PMCID: PMC9167457.
https://doi.org/10.5144/0256-4947.2022.204
11. Pasrija S, Trivedi SS, Narula MK. Prospective study of saline infusion sonohysterography in evaluation of perimenopausal and postmenopausal women with abnormal uterine bleeding. J Obstet Gynaecol Res. 2004 Feb;30(1):27-33. doi: 10.1111/j.1341-8076.2004.00151.x. PMID: 14718017.https://doi.org/10.1111/j.1341-8076.2004.00151.x
12. de Vries LD, Dijkhuizen FP, Mol BW, Brölmann HA, Moret E, Heintz AP. Comparison of transvaginal sonography, saline infusion sonography, and hysteroscopy in premenopausal women with abnormal uterine bleeding. J Clin Ultrasound. 2000 Jun;28(5):217-23. doi: 10.1002/(sici)1097-0096(200006)28:5<217::aid-jcu2>3.0.co;2-b. PMID: 10799999.
https://doi.org/10.1002/(SICI)1097-0096(200006)28:5<217::AID-JCU2>3.0.CO;2-B
13. Erdem M, Bilgin U, Bozkurt N, Erdem A. Comparison of transvaginal ultrasonography and saline infusion sonohysterography in evaluating the endometrial cavity in pre- and postmenopausal women with abnormal uterine bleeding. Menopause. 2007 Sep-Oct;14(5):846-52. doi: 10.1097/gme.0b013e3180333a6b. PMID: 17429332.
https://doi.org/10.1097/gme.0b013e3180333a6b
14. Chawla I, Tripathi S, Vohra P, Singh P. To Evaluate the Accuracy of Saline Infusion Sonohysterography (SIS) for Evaluation of Uterine Cavity Abnormalities in Patients with Abnormal Uterine Bleeding. J Obstet Gynaecol India. 2014 Jun;64(3):197-201. doi: 10.1007/s13224-013-0501-4. Epub 2014 Jan 4. PMID: 24966505; PMCID: PMC4061335.
https://doi.org/10.1007/s13224-013-0501-4
15. Kaveh M, Sadegi K, Salarzaei M, Parooei F. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography, and hysteroscopy in evaluating the endometrial polyps in women with abnormal uterine bleeding: a systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne. 2020 Sep;15(3):403-415. doi: 10.5114/wiitm.2020.93791. Epub 2020 Mar 19. PMID: 32904526; PMCID: PMC7457193.
https://doi.org/10.5114/wiitm.2020.93791
16. Bingol B, Gunenc MZ, Gedikbasi A, Guner H, Tasdemir S, Tiras B. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy in postmenopausal bleeding. Arch Gynecol Obstet. 2011 Jul;284(1):111-7. doi: 10.1007/s00404-010-1604-0. Epub 2010 Jul 28. PMID: 20665218.
https://doi.org/10.1007/s00404-010-1604-0
17. Vroom AJ, Timmermans A, Bongers MY, van den Heuvel ER, Geomini PMAJ, van Hanegem N. Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2019 Jul;54(1):28-34. doi: 10.1002/uog.20229. Epub 2019 Jun 12. PMID: 30693579.https://doi.org/10.1002/uog.20229
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Copyright (c) 2026 Dr. Swetha K. M., Dr. Keerti Shivaputrappa, Dr. Sonia H (Author)
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