Abnormal uterine bleeding. Accuracy of vaginal probe ultrasound in predicting abnormal hysteroscopic findings.

OBJECTIVE

To determine the accuracy of vaginosonography in predicting the presence of abnormal intrauterine findings at hysteroscopy in women presenting with abnormal uterine bleeding.

STUDY DESIGN

Two hundred thirty-eight women between the ages of 25 and 75 were evaluated for abnormal uterine bleeding by a combination of vaginal probe ultrasound, hysteroscopy and suction curettage. Ultrasound findings were classified as normal, abnormal or equivocal, and hysteroscopic findings as normal or abnormal. The ability of findings on ultrasound to predict a normal or abnormal hysteroscopic examination was evaluated.

RESULTS

Ultrasound examination was normal, equivocal and abnormal in 57 (24%), 78 (33%) and 103 (43%) patients, respectively. If equivocal scans are excluded, ultrasound had a positive predictive value of 87%, negative predictive value of 89%, sensitivity of 94% and specificity of 89%. If equivocal scans are considered abnormal, the positive predictive value of an abnormal ultrasound examination was 75%, negative predictive value was 89%, sensitivity 96% and specificity 53%. Vaginosonography detected 99% of submucous myomas and 89% of endometrial polyps.

CONCLUSION

Normal and abnormal vaginal probe ultrasound examination of the uterus is effective in predicting the presence or absence of endometrial pathology as determined by hysteroscopy and suction curettage. Vaginal probe ultrasound is an excellent screening examination for the presence of intrauterine pathology and can assist in planning further evaluation and treatment.