Can salin infusion sonohysterography (SIS) replace diagnostic hysteroscopy in the uterine cavity evaluation of infertile women?

OBJECTIVE: To evaluate the role of sonohysterography in the diagnosis of intrauterine pathology in comparison to hysteroscopy.
DESIGN: Prospective study using sonohysterography as a first step exam- ination of uterine cavity in a group of infertile women during 18 months.
MATERIALS AND METHODS: 444 sonohysterography were per- formed from January 2005 to april 2007. The mean age of patients was 35 (range 23-42). In 23 patients the exam was not possible due to cervical stenosis (5,2%). The sonohysterography was performed between 10-15 day of the menstrual cycle. If a diagnosis of possible intrauterine anomaly was made at sonohysterography, hysteroscopy was scheduled. Comparative re- sults of sonohysterography and hysteroscopy has been analyzed. Positive predictive value (PPV) and specificity of sonohysterography have been calculated.
RESULTS: In 58 of 421 patients (15,4%), sonohysterography showed an abnormal uterine cavity: 36 polyps (8,5%), 3 submucous myomas (0,7%), 18 uterine malformation (4,3%), 1 synechiae (0,2%), 7 non accessible cavity (1,7%). Among these patients, 51 underwent diagnostic hysteroscopy. Hys- teroscopy revealed 34 polyps, 2 myomas, 1 synechiae, 9 uterine malforma- tion and 3 normal cavity. PPV of sonohysterography was 94% for polyps detection, 100% for myomas, 100% for synechiae, 90% for uterine malfor- mation. Overall PPV has been 94%.
CONCLUSIONS: Sonohysterography is a simple, low cost and well toler- ated procedure. Diagnostic accuracy and the low false positive rate suggest sonohysterography as a routine test in the evaluation of the uterine cavity of infertile women.