Hysterosonography as an adjunct to transvaginal sonography in the evaluation of intraluminal lesions of the uterine cavity.

Objective: Hysteroscopy is a simple technique that can be used to outline the contours of the uterine cavity under real-time ultrasound guidance. This study was undertaken to determine whether hysterosonography can be used as an adjunct to transvaginal sonography in predicting either the presence or absence of intraluminal lesions in the uterine cavity and in distinguishing these lesions from subendometrial or myometrial lesions.Methods: In this retrospective analysis, 1,467 transvaginal sonograms performed in the office of a single gynecologic oncology practice from March 1996 through June 1997 were reviewed. Of these, 38 sonograms were considered to have possible intraluminal lesions of the uterine cavity and thus further evaluated by hysterosonography. The principle investigator performed all the hysterosonograms by infusing 15-30 mL of sterile saline directly into the uterine cavity using a Soules 5.3F transcervical catheter. Real-time transvaginal sonography was performed simultaneously, and representative images were compared with the initial transvaginal sonograms.Results: Successful hysterosonograms were obtained in 36 patients (97.3%). One patient had cervical stenosis from a previous conization, precluding access to the uterine cavity. The hysterosonography was tolerated well by the patients with minimal discomfort. There was no incidence of endometritis. The median age was 56.2 years. Postmenopausal bleeding was the most common presenting symptom (30.0%). The indications for hysterosonography were abnormal findings on the initial transvaginal sonograms including lesions suggestive of intraluminal mass (73.0%), thickened endometrial stripe (13.5%), and increased echogenicity (10.8%). Hysterosonography revealed presence of intraluminal masses in only 11 of the 31 cases (35.5%) that had been suggested to contain either a mass or thickened endometrial stripe. Subsequent hysteroscopy, dilatation, and curettage confirmed the presence of endometrial polyp in all 11 cases. The remaining 65.5% contained no intraluminal masses or thickened endometrial stripe.Conclusion: Hysterosonography can be a valuable adjunct to transvaginal sonography and may be used in selected cases to eliminate the need for hysteroscopy, dilatation, and curettage.