(SIS) over the transvaginal ultrasonography (TVS) in detecting endometrial and subendometrial lesions
determined by direct visualization of the intrauterine cavity with hysteroscopy.
Patients and Methods: Between October 2002 through august 2004, 58 patients with persistent abnormal
uterine bleeding despite at least 3 months of medical treatment were referred for TVS, SIS as well as
hysteroscopy and biopsy.
Results: twenty three patients were confirmed to have intracavitary uterine abnormality. SIS was
able to identify all patients with endometrial and subendometrial abnormalities in comparison to TVS
which identified only 15 patients, and SIS was able to identify 31 of the 35 patients reported normally
by hysteroscopy in comparison to 32 patients by TVS. SIS yielded a sensitivity of 100%, a specificity of
88.6%, a positive predictive value of 85.2%, and a negative predictive value (NPV) of 100%. Whereas
TVS yielded a sensitivity of 65.2%, a specificity of 91.4%, a positive predictive value of 83.3%, and a
negative predictive value of 80%.
Conclusion: SIS is simple non-invasive inexpensive procedure that yields additional information over
TVS. It allows reliable differentiation between focal and diffuse endometrial and subendometrial lesions.
It has equal sensitivity and NPV as hysteroscope and offers substantial advantages over hysteroscopy in
terms of time, cost, patient comfort, availability, and risk. Its use could be implemented as a standard test
in patients with abnormal uterine bleeding regardless of the results of the transvaginal ultrasonography and
before the consideration of hysteroscopy.