Clinical utility of saline solution infusion sonohysterography in a primary care obstetric-gynecologic practice

OBJECTIVE: The purpose of this study was to evaluate the role of saline solution infusion sonohysterography in clinical practice in patients with abnormal uterine bleeding. STUDY DESIGN: A prospective case-controlled study was conducted comparing two-dimensional transvaginal imaging with saline solution infusion sonohysterography, endometrial biopsies, and histologic evaluation after surgical procedures. One hundred twenty-four patients with abnormal uterine bleeding were scanned transabdominally and transvaginally. Patients with an increased endometrial thickness or a poorly defined endometrium underwent saline solution infusion sonohysterography. Sterile saline solution, 4 to 10 ml, was injected into the endometrial cavity under direct ultrasonographic visualization. Once the endometrium was expanded, the presence of polyps or myomas and the anterior and posterior endometrial thickness was assessed. RESULTS: Fifty-six patients were noted to have uterine leiomyomas. Eighteen patients had endometrial polyps. Five patients had simple endometrial hyperplasia. Two patients had atypical hyperplasia. No patients in this study had endometrial cancer. No complications occurred in this group of patients. CONCLUSION: Saline solution infusion sonohysterography is a procedure that aids the clinician in the management of abnormal uterine bleeding and may be more cost effective than traditional methods of evaluation.