Engin KORKMAZER, Vehbi Yavuz TOKGÖZ, Tufan ÖĞE, Ahmet Başar TEKİN

The comparison of saline infusion sonography and transvaginal sonography for the intracavitary lesions in infertile women

Aim: The aim of this study is to compare the diagnostic accuracy of transvaginal sonography and saline infusion sonography in thedetection of intracavitary space-occupying lesions (endometrial polyp and submucous fibroid) in infertile women.Material and Methods: Three hundred and twenty-three women with infertility were involved in this retrospective study. Thediagnostic accuracy of transvaginal sonography and saline infusion sonography were compared with respect to evaluation bydiagnostic hysteroscopy results. The sensitivity, specificity, predictive values and ROC curves were used to determine the efficacy ofmethods for detecting the intracavitary space-occupying lesions in infertile patients.Results: The incidence of intracavitary space-occupying lesions was 82.1% infertile women. The endometrial polyp and submucousfibroid were established in 56 (17.3%) and 5(1.5%) patients, respectively. The sensitivity and specificity of transvaginal sonographywere 50.8% and 98.1%, respectively. These values were 80.3% and 98.5% for saline infusion sonography, respectively. Saline infusionsonography was found superior to transvaginal sonography for evaluating the intracavitary space-occupying lesions.Conclusion: Saline infusion sonography was more accurate diagnostic modality than transvaginal sonography to assess theintracavitary space-occupying lesions in the infertility population. Therefore the addition of saline infusion sonography to theinfertility workup may prevent unnecessary invasive procedures to evaluate the uterine cavity

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1. Cakmak H, Taylor HS. Implantation failure: molecular mechanisms and clinical treatment. Hum Reprod Update 2011;17:242-53.
2. Shalev J, Meizner I, Bar-Hava I, et al. Predictive value of transvaginal sonography performed before routine diagnostic hysteroscopy for evaluation of infertility. Fertil Steril 2000;73:412-7.
3. Dubinsky TJ. Value of sonography in the diagnosis of abnormal vaginal bleeding. J Clin Ultrasound 2004;32:348-53.
4. Hajishaiha M, Ghasemi-Rad M, Karimpour N, et al. Transvaginal sonographic evaluation at different menstrual cycle phases in diagnosis of uterine lesions. Int J Womens Health 2011;3:353-7.
5. Yauger BJ, Feinberg EC, Levens ED, et al. Pre-cycle saline infusion sonography minimizes assisted reproductive technologies cycle cancellation due to endometrial polyps. Fertil Steril 2008;90:1324-6.
6. Shushan A, Rojansky N. Should hysteroscopy be a part of the basic infertility workup? Hum Reprod 2000;15:1650.
7. Lo KW, Yuen PM. The role of outpatient diagnostic hysteroscopy in identifying anatomic pathology and histopathology in the endometrial cavity. J Am Assoc Gynecol Laparosc 2000;7:381-5.
8. Nayak PK, Mahapatra PC, Mallick J, et al. Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients. J Hum Reprod Sci 2013;6:32-4.
9. Brown SE, Coddington CC, Schnorr J, et al. Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: a prospective, randomized study. Fertil Steril 2000;74:1029-34.
10. Bingol B, Gunenc Z, Gedikbasi A, et al. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy. J Obstet Gynaecol 2011;31:54-8.
11. Tokmak A, Ersoy E, Ersoy AÖ, et al. The Effect of Age on Clinical and Laboratory Parameters in Reproductive Age Women with Endometrial Polyps. Gynecol Obstet Reprod Med 2016;20:154-8.
12. Mollo A, De Franciscis P, Colacurci N, et al. Hysteroscopic resection of the septum improves the pregnancy rate of women with unexplained infertility: a prospective controlled trial. Fertil Steril 2009;91:2628-31.
13. Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 2009;91:1215-23.
14. Vercellini P, Cortesi I, Oldani S, et al. The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia. Hum Reprod 1997;12:1768-71.
15. Seshadri S, El-Toukhy T, Douiri A, et al. Diagnostic accuracy of saline infusion sonography in the evaluation of uterine cavity abnormalities prior to assisted reproductive techniques: a systematic review and meta-analyses. Hum Reprod Update 2015;21:262-74.
16. Ragni G, Diaferia D, Vegetti W, et al. Effectiveness of sonohysterography in infertile patient work-up: a comparison with transvaginal ultrasonography and hysteroscopy. Gynecol Obstet Invest 2005;59:184-8.
17. Reda A, Hamid AS, Mostafa R, et al. Comparison between findings of saline infusion sonohysterography and office hysteroscopy in patients with recurrent implantation failure. J Hum Reprod Sci 2016;9:236-40.
18. Kelekci S, Kaya E, Alan M, et al. Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding. Fertil Steril 2005;84:682-6.
19. de Kroon CD, de Bock GH, Dieben SW, et al. Saline contrast hysterosonography in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG 2003;110:938-47.
20. Grimbizis GF, Tsolakidis D, Mikos T, et al. A prospective comparison of transvaginal ultrasound, saline infusion sonohysterography, and diagnostic hysteroscopy in the evaluation of endometrial pathology. Fertil Steril 2010;94:2720-5.
21. Yenigul N, Yazici Yilmaz Y, Bahat N, et al. The comparison of transvaginal ultrasonography and hysteroscopy in women with abnormal uterine bleeding: A single center experience. Annals of Medical Research 2019;26:1112-7.
22. van Dongen H, Timmermans A, Jacobi CE, et al. Diagnostic hysteroscopy and saline infusion sonography in the diagnosis of intrauterine abnormalities: an assessment of patient preference. Gynecol Surg 2011;8:65-70.
23. Almog B, Shalom-Paz E, Shehata F, et al. Saline instillation sonohysterography test after normal baseline transvaginal sonography results in infertility patients. Is it justified? Gynecol Endocrinol 2011;27:286-9.
24. van Dongen H, de Kroon CD, Jacobi CE, et al. Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG 2007;114:664-75.
25. Ogutcuoglu B, Karadag C, Inan C, et al. Diagnostic utility of saline infusion doppler sonohysterography in endometrial mass lesions. Pak J Med Sci 2016;32:284-8.
26. Pasrija S, Trivedi SS, Narula MK. Prospective study of saline infusion sonohysterography in evaluation of perimenopausal and postmenopausal women with abnormal uterine bleeding. J Obstet Gynaecol Res 2004;30:27-33.
27. Erdem M, Bilgin U, Bozkurt N, et al. Comparison of transvaginal ultrasonography and saline infusion sonohysterography in evaluating the endometrial cavity in pre- and postmenopausal women with abnormal uterine bleeding. Menopause 2007;14:846-52.
28. Milingos S, Kallipolitis G, Stefanidis K, et al. Saline contrast hysterosonography in infertile patients and in women with abnormal uterine bleeding. Eur J Gynaecol Oncol 2005;26:564-7.
29. van Dongen H, de Kroon CD, van den Tillaart SA, et al. A randomised comparison of vaginoscopic office hysteroscopy and saline infusion sonography: a patient compliance study. BJOG 2008;115:1232-7.
30. Short J, Sharp B, Elliot N, et al. Does the addition of saline infusion sonohysterography to transvaginal ultrasonography prevent unnecessary hysteroscopy in premenopausal women with abnormal uterine bleeding? Aust N Z J Obstet Gynaecol 2016;56:432-5.