Saline infusion sonography compared to hysteroscopy for uterine cavity evaluation in abnormal uterine bleeding

Introduction
Evaluation of abnormal uterine bleeding (AUB) in women ≥ 40 years or menopausal women is of critical importance to confirm the benign nature of the problem, and to exclude endometrial carcinoma. This study was designed to evaluate the accuracy of saline infusion sonography (SIS) compared to hysteroscopy in diagnosing uterine cavity abnormalities in cases of AUB.

Material and methods
One hundred and eighty-six women diagnosed with AUB were included in this comparative study, and agreed to have SIS, beside the hysteroscopic assessment of the uterine cavity.

Results
In this study, hysteroscopy was more sensitive (98.7% vs. 97.4%), more specific (100% vs. 99.1%), and more accurate (99.5% vs. 98.4%) than SIS. In addition, hysteroscopy had higher predictive values, 100% positive predictive value, and 99.1% negative predictive value compared to 98.7% positive predictive value, and 98.2% negative predictive value for SIS in diagnosis of uterine cavity abnormalities. However, these differences were not statistically significant (p > 0.05).

Conclusions
Saline infusion sonography is a simple, well-tolerated procedure that can be used in an outpatient setting to diagnose uterine cavity anomalies in cases of abnormal uterine bleeding when outpatient hysteroscopy is not available or as a complementary tool to confirm the diagnosis detected by hysteroscopy.