Fertility and sterility vol:95 issue:1 pages:285-288
OBJECTIVE: To compare saline infusion sonography (SIS) with gel instillation sonography (GIS) in terms of feasibility and diagnostic accuracy. DESIGN: Prospective cohort study. SETTING: Leuven University bleeding clinic. PATIENT(S): A total of 804 patients: two consecutive cohorts of 402 women undergoing SIS or GIS. INTERVENTION(S): Vaginal ultrasound (n = 804) followed by SIS (n = 402) or GIS (n = 402); office hysteroscopy in 685 patients, and endometrium sampling in 487 patients; surgery in 274 women: operative hysteroscopy (n = 230) or hysterectomy (n = 44). MAIN OUTCOME MEASURE(S): Patients' characteristics, technical failure rates, and final diagnosis. Pathology was defined as endometrial hyperplasia, polyp, cancer, or intracavitary myomas. RESULT(S): The technical failure rate (difference between proportions and confidence interval) was 5.0% for SIS versus 1.8% for GIS, respectively (3.21; [0.69-5.95]). Failure due to inadequate distension was 1.5% versus 0.3% for SIS and GIS, respectively (1.25; [-0.16-2.99]). Pathology was diagnosed in 180 patients (49%) of the SIS group versus 147 patients of the GIS group (40.2%) (8.88; [1.69-15.95]). The sensitivity was 77.8% and 85.0%, respectively (NS). The negative predictive value was 79.1% for SIS and 88.6% for GIS (9.54; [2.17-16.89]). CONCLUSION(S): Gel instillation sonography is a feasible, accurate alternative for SIS in the evaluation of women with abnormal bleeding, and has fewer technical failures.