Hysteroscopy and 3D Ultrasound for Diagnosing Uterine Cavity Abnormalities: A Comparative Study

Background: Evaluation of Uterine cavity can be done using hysterosalpingography (HSG), Trans Vaginal Ultrasonography (TVS), Sonohysterography (SHG) and Hysteroscopy. Uterine cavity abnormalities, e.g endometrial polyps, submucous myomas, intra- uterine adhesions, endometritis and uterine septum may result in abnormal uterine bleeding (AUB) in the form of menorrhagia or metrorrhagia or failure to conceive. Hence exclusion of intrauterine pathology is important for abnormal uterine bleeding and infertility treatment.

Objective: To compare diagnostic accuracy and efficacy of three dimensional transvaginal ultrasound (3D-TVS) and hysteroscopy in detecting uterine cavity abnormalities, in patients with abnormal uterine bleeding and infertility.

Design and Setting: An Observational Prospective Study in the Department of Obstetrics & Gynecology in the Institute of Kidney disease & Research Centre, Civil Hospital, Ahmedabad, India from January 2018 to February 2019 was conducted.

Material and Methods: Two hundred patients with abnormal uterine bleeding and infertility were studied prospectively. 100 patients had Abnormal Uterine Bleeding as chief complaint and 100 patients had Infertility as chief complaint. 2Dimensional (2D) Transvaginal Ultrasonography followed by 3Dimensional (3D) Ultrasonography and hysteroscopy were performed in the mid to late follicular phase of menstrual cycle. Uterine cavity characteristics and abnormalities were noted.

Results: Qualitative data were presented as number and percentage. Comparisons between groups were estimated by chi-square test. Abnormal findings were detected in 32.5% patients by hysteroscopy and in 20% patients by 3D Ultrasonography. A probability value (p value) < 0.01 was considered significant . Endometrial Polyp was detected in 14% of patients on hysteroscopy as compared to 7.5% patients by 3D Ultrasonography with p-value <0.04

Conclusion: Hysteroscopy is a safe and reliable procedure to evaluate benign endometrial lesion, direct visualization of uterine cavity with high diagnostic accuracy. It has the advantage of simultaneous treatment or biopsy procedures in few cases while 3D USG is non invasive and good tool for basic evaluation of uterus and adnexa.