Diagnostic accuracy at sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases

Objective: To evaluate the diagnostic accuracy of sonohysterography (SHG) in uterine cavity diseases in infertile patients, comparing its results with those of hysterosalpingography (HSG) and transvaginal sonography (TVS). Hysteroscopy was the gold standard. Design: Descriptive, prospective study. Setting: A tertiary university referral center. Patient(s): Sixty-five infertile women 19 to 43 years of age. Intervention(s): Patients underwent SHG, conventional TVS, HSG, and hysteroscopy. Main Outcome Measure(s): The results of each examination were compared with those obtained by the gold standard. The following diagnoses were considered separately: polypoid lesions, uterine malformations, intrauterine adhesions, and endometrial hyperplasia (EH). Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and 95% confidence intervals were calculated. Result(s): Sonohysterography had the same diagnostic accuracy as the gold standard for polypoid lesions and EH, with no equivocal diagnosis. Hysterosalpingography showed a sensitivity of 50% and a PPV of 28.6% for polypoid lesions and a sensitivity of 0% for EH Transvaginal sonography had both sensitivity and PPV of 75% for polypoid lesions and EN. For uterine malformations, SHG had a sensitivity of 77.8%, whereas TVS and HSC both had a sensitivity of 44.4%. Sonohysterography and HSC had a sensitivity of 75% in the detection of intrauterine adhesions and respective PPVs of 42.9% and 50%. Transvaginal sonography showed sensitivity and PPV of 0% for this diagnosis. Conclusion(s): Sonohysterography was in general the most accurate lest. Ifs diagnostic accuracy was markedly superior for polypoid lesions and EH, with total agreement with the gold standard. In diagnosis of intrauterine adhesions, SHG had limited accuracy, similar to that obtained by HSG, with a high false-positive diagnosis rate. (Fertil Steril(R) 2000;73:406-11. (C)2000 by American Society for Reproductive Medicine.).