Pasrija Shikha, Trivedi Shubha Sagar, Narula Mahinder Kaur
Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India.
J Obstet Gynaecol Res. 2004 Feb;30(1):27-33. doi: 10.1111/j.1341-8076.2004.00151.x.
To evaluate saline infusion sonohysterography as an investigative modality in abnormal uterine bleeding in perimenopausal and postmenopausal women.
Fifty-eight patients, 52 perimenopausal and six postmenopausal women, with abnormal uterine bleeding were selected from the department of Obstetrics and Gynecology of Shrimati Sucheta Kriplani Hospital. After complete work-ups, transvaginal examinations were performed followed by sonohysterographies. The sensitivity, specificity, positive predictive values and negative predictive values were calculated for transvaginal sonography (TVS) and saline infusion sonohysterography as compared with findings of hysteroscopy/hysterectomy.
Saline infusion sonohysterography was performed in 56 cases. It could not be done in one perimenopausal and one postmenopausal woman. Cavity was normal in 41 perimenopausal and five postmenopausal women. Ten women displayed abnormalities. Two had submucosal fibroids, two had intramural fibroids, one had fibroid polyp, three had endometrial polyps and two patients had endometrial growths. We found that TVS missed three endometrial polyps and one endometrial growth and led to mislabeling two intramural fibroids as submucosal. On comparing the sonohysterographic findings with those of hysteroscopy or hysterectomy, one endometrial polyp and one endocervical polyp was missed on sonohysterography, and one false positive growth was observed on sonohysterography. The sensitivity, specificity, positive predictive value and the negative predictive value of TVS were 84.8%, 79%, 82.4% and 82%, respectively. The sensitivity, specificity, positive predictive value and the negative predictive value of saline infusion sonohysterography were 94.1%, 88.5%, 91.4% and 92%, respectively.
Saline infusion sonohysterography is a safe, convenient, time conserving, cost effective, easily accessible and acceptable investigative modality. It definitely enhances the diagnostic potential of TVS in assessment of endometrium and intracavitary pathologies.
评估生理盐水灌注子宫声学造影作为围绝经期和绝经后妇女异常子宫出血的一种检查方法。
从苏切塔·克里普拉尼夫人医院妇产科选取58例异常子宫出血患者，其中52例围绝经期妇女，6例绝经后妇女。在完成全面检查后，先进行经阴道检查，随后进行子宫声学造影。将经阴道超声检查（TVS）和生理盐水灌注子宫声学造影的结果与宫腔镜检查/子宫切除术的结果进行比较，计算其敏感性、特异性、阳性预测值和阴性预测值。
56例患者进行了生理盐水灌注子宫声学造影。1例围绝经期妇女和1例绝经后妇女无法进行该检查。41例围绝经期妇女和5例绝经后妇女宫腔正常。10例妇女显示有异常。2例有黏膜下肌瘤，2例有肌壁间肌瘤，1例有肌瘤息肉，3例有子宫内膜息肉，2例有子宫内膜增生。我们发现TVS漏诊了3例子宫内膜息肉和1例子宫内膜增生，并将2例肌壁间肌瘤误诊为黏膜下肌瘤。将子宫声学造影结果与宫腔镜检查或子宫切除术结果进行比较，子宫声学造影漏诊了1例子宫内膜息肉和1例宫颈息肉，且观察到1例假阳性增生。TVS的敏感性、特异性、阳性预测值和阴性预测值分别为84.8%、79%、8,2.4%和82%。生理盐水灌注子宫声学造影的敏感性、特异性、阳性预测值和阴性预测值分别为94.1%、88.5%、91.4%和92%。
生理盐水灌注子宫声学造影是一种安全、便捷、省时、经济、易于获得且可接受的检查方法。它确实提高了TVS在评估子宫内膜和宫腔内病变方面的诊断潜力。
