THREE-DIMENSIONAL SONOHYSTEROGRAPHY IN THE EVALUATION OF INTRAUTERINE PATHOLOGY: COMPARISON WITH TWO-DIMENSIONAL SONOHYSTEROGRAPHY AND SURGICAL EVALUATION OF THE ENDOMETRIAL CAVITY

S.J. Kerrigan, D.D. Johnson

Ashley River Ob/Gyn, Charleston, SC

OBJECTIVE: We sought to measure the accuracy of two-dimensional (2D) and three-dimensional (3D) sonohysterography in the detection of intrauterine lesions.

MATERIALS AND METHODS: Thirty-eight of forty consecutive women referred to a university-based ultrasound unit for sonohysterography between November 1999 and February 2001 were successfully evaluated with 2D and 3D ultrasound during sonohysterography.  Eighteen women subsequently underwent surgical evaluation of the endometrial cavity and were included for analysis.  One physician interpreted all 2D studies, while a different physician, blinded to the 2D results, interpreted the 3D findings.  Data regarding surgical findings and pathologic results were obtained and recorded.  Surgical findings were then compared with the 2D and 3D sonohysterography results.

RESULTS: The indications for sonohysterography were menorrhagia (7), dysfunctional uterine bleeding (5), postmenopausal bleeding (4), fibroids (1), and metrorrhagia (1).  The mean age of study subjects was 48.6 years.  Surgical findings identified 7 polyps, 5 submucous myomas, one “atypical glandular endometrium” and 7 normal endometrial cavities.  For the diagnosis of polyps, 2D sonohysterography revealed a sensitivity of 85.7%, a specificity of 81.8%, and positive predictive value (PPV) of 75%, while 3D sonohysterography had a sensitivity of 28.6%, specificity 63.6%, and PPV of 33.3%.  For submucous myomas, 2D sonohysterography had a sensitivity of 100%, specificity 92.3%, and PPV of 83.3%, while 3D sonohysterography revealed a sensitivity of 100%, specificity 76.9%, and PPV 62.5%.

CONCLUSIONS: In this study, 3D ultrasound did not improve upon the accuracy of 2D sonohysterography in the evaluation of endometrial lesions.

Key Words:  sonohysterography, three-dimensional ultrasound, two-dimensional ultrasound

Disclosure – Consultant: S. Kerrigan, Novartis.