Diagnostic accuracy of sonohysterography compared to endometrial biopsy in pre-menopausal women with abnormal uterine bleeding

  Background: AUB is a common cause of women’s referring to gynecologists. Although hysteroscopy is known as the gold standard technique for diagnosing the cause of AUB, sonohysterography is less invasive, and it is performed by general gynecologists. The purpose of this study was to evaluate the diagnostic performance of sonohysterography compared to the results of the endometrial biopsy, guided by hysteroscopy in premenopausal women with AUB.   Methods : This cross- sectional Study was conducted at the gynecological clinic of Roointan -Arash women's Hospital from February 2011 to February 2012. The study participants were 90 premenopausal female patients, who visited the clinic for AUB, for whom, hormonal, iatrogenic and systemic causes were ruled out. They underwent sonohysterography and hysteroscopy and endometrial biopsy. The results of sonohysterography and pathological reports of endometrial biopsy were compared, and the diagnostic accuracy of sonohysterography for normal endometrium, endometrial polyps, sub mucosal fibroids and endometrial hyperplasia was evaluated.   Results : The diagnostic accuracy of sonohysterography was found to be 89.1% for the normal endometrium, 90% for endometrial polyps, 99% for sub mucosal fibroids and 94.4% for endometrial hyperplasia.   Conclusion : Sonohysterography is an accurate, non-invasive and cost-effective method for diagnosing AUB causes compared to hysteroscopy and endometrial biopsy. Therefore, as an initial diagnostic step, it can replace the alternative and less accurate methods such as transvaginal ultrasound, blind endometrial curettage or more costly and invasive methods such as hysteroscopy requiring anesthesia.