Role of Transvaginal Ultrasonography, Hysterosonography and Hysteroscopy in the Diagnosis of Abnormal Uterine Bleeding

Objective: To evaluate the diagnostic accuracy of transvaginal ultrasonography, sonohysterography and diagnostic hysteroscopy in premenopausal and postmenopausal patients with abnormal uterine bleeding. Materials and Methods: In this prospective randomised study, women who complained of abnormal uterine bleeding, 84 cases were evaluated from October 1 2002 to December 31 2003. The patients' ages ranged 25 to 77 years. The patients were divided into two groups. Group A (42 patients) underwent transvaginal ultrasonography, group B (42 patients) underwent sonohysterography. All patients then had office diagnostic hysteroscopy or operative hysteroscopy. The final diagnosis was made by operative hysteroscopy with resection and excision of the lesions or endometrial biopsy with vacum curettage. Sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography, sonohysterography and diagnostic hysteroscopy were calculated. Results: The mean age was 49.1 years. Fourty nine patients were in premenopausal, and 35 were in postmenopausal period. They complained of abnormal uterine bleeding such as menorrhagia (18 patients), metrorrhagia (12 patients), menometrorrhagia (17 patients), postmenopausal bleeding (35 patients). The most common causes for the abnormal uterine bleeding were endometrial hyperplasia in transvaginal ultrasonography (61.9%), endometrial polyp in sonohisterography (76.1%), and also endometrial polyp in diagnostic hysteroscopy (52.3%). Transvaginal ultrasonography revealed a sensitivity of 68.1% and specificity of 35%. Sonohysterography revealed a sensitivity of 88.8% and specificity of 50%. Diagnostic hysteroscopy revealed a sensitivity of 83.3% and specificity of 75%. Conclusion: Sonohysterography offer a minimal invazive and cost-effective alternative to diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding and can be the most effective method to reduce the number of diagnostic hysteroscopies.