Assessment of Perimenopausal Bleeding Using Three-Dimensional Hysterography, Hysteroscopy, and Histopathology

Background Abnormal uterine bleeding is a very common gynecological problem, especially in perimenopausal women. Intracavitary lesions have been reported in more than 40% of the referred patients. Objectives To compare the diagnostic accuracy of 3-dimensional sonohysterography (3D-SHG) versus hysteroscopy in the evaluation of uterine cavity in patients with perimenopausal bleeding and suspected intracavitary lesions, to evaluate the correlations between these findings and histopathological results, and to determine if 3D-SHG is superior or comparable to hysteroscopy in the diagnosis of these lesions. Methods A total of 50 women with perimenopausal bleeding and suspected intracavitary lesions, detected by either 2D transvaginal ultrasound or hysterosalpingography, were subjected to 3D saline-infusion sonohysterography (3D-SIS), office hysteroscopy, subsequent surgical procedures (i.e., fractional curettage, hysterectomy, polypectomy, or myomectomy), and finally histopathological examinations. Results and Conclusions Based on the findings, 3D-SIS is comparable to hysteroscopy in the diagnosis of intracavitary lesions in terms of sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy (97.83%, 100%, 100%, 80%, and 98%, respectively for 3D-SIS vs. 100%, 100%, 100%, 100%, and 100%, respectively for office hysteroscopy).