Diagnostic Accuracy of Saline Infusion Sonohysterography versus Hysteroscopy in Detecting the Endometrial Polyps in Women with Abnormal Uterine Bleeding

Abstract

Objective: To evaluate the diagnostic accuracy of saline infusion sono-hysterography (SISH) in identifying endometrial polyps in women with abnormal uterine bleeding (AUB) taking hysteroscopy as gold standard

Methodology: This Hospital-based Cross-sectional study was done at the Department of Obstetrics and Gynecology, Sir Ganga Ram Hospital, Lahore. Women aged 25 to 40 years who presented with abnormal uterine bleeding and either showed endometrial polyps on transvaginal sonography (TVS) or had an endometrial thickness exceeding 10 mm were included. Patients were further evaluated with SISH under the supervision of radiologist and with positive findings the patients then underwent hysteroscopy for confirmation. SISH was carried out using a sterile Foley catheter and transvaginal ultrasound, following strict aseptic techniques. The presence or absence of endometrial polyps was recorded, and data were analyzed using SPSS version 25.

Results: The average age was 33.18 ± 4.31 years, and the mean BMI was 26.32 ± 2.94 kg/m². SISH and hysteroscopy both detected polyps in 70% of cases. Overall SISH showed 94.29% sensitivity meaning it correctly identified approximately 94 out of every 100 true polyp cases, sensitivity specificity 86.67%, positive predictive value (PPV) 94.29%, negative predictive value (NPV) 86.67%, and overall diagnostic accuracy of SISH 92.00%. No significant association was found between age (p = .577) or parity (p = .412) and polyp detection, while raised BMI and longer symptoms duration were significantly associated with polyp detection, (p >0.05).

Conclusion: SISH was evaluated as a minimally invasive, cost effective alternative, showed high sensitivity and accuracy taking hysteroscopy as the gold standard.