Histerossonografia: avaliação da cavidade uterina com sangramento anormal

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Abstract

OBJETIVO: Comparar a acurácia da histerossonografia com as da histeroscopia e da USG no diagnóstico das alterações uterinas em mulheres com sangramento uterino anormal. MÉTODOS: Foram incluídas 53 pacientes que estavam agendadas para realização de histeroscopia no Setor de Histeroscopia do CAISM/UNICAMP. Comparou-se a sensibilidade e especificidade dos três métodos propedêuticos utilizando a histologia como padrão ouro. RESULTADOS: A sensibilidade da histerossonografia e da histeroscopia foi de 94% e a da USG 83%. A especificidade da histerossonografia foi de 77%, da histeroscopia de 91% e da USG 69%. As diferenças entre as sensibilidades dos três métodos não foram estatisticamente significativas, no entanto observou-se diferença significativa entre a especificidade da USG e da histeroscopia. A histerossonografia mostrou maior capacidade que a ultra-sonografia de identificar pólipos endometriais. CONCLUSÃO: A histerossonografia pode ser utilizada como método complementar à USG e substituto da histeroscopia para o diagnóstico de alterações que levam ao sangramento uterino anormal.

Translated abstract

OBJECTIVE: To compare the diagnostic accuracy of sonohysterography with that of hysteroscopy and ultrasonography for the diagnosis of uterine alterations with abnormal uterine bleeding. METHODS: Fifty three patients scheduled for hysteroscopy at the Hysteroscopy Sector of the Women's Hospital (CAISM) at the "Universidade Estadual de Campinas" (Brazil) were included in the study. Sensitivity and specificity of the three propaedeutic methods were compared using histology as the gold standard. RESULTS: Sensitivity of sonohysterography and of hysteroscopy was 94% and that of ultrasonography 83%. The specificity of sonohysterography was 77%, of hysteroscopy 91% and of ultrasonography 69%. There were no significant differences between sensitivities of the three methods. However, a significant difference was found between the specificity of ultrasonography and hysteroscopy. Sonohysterography demonstrated a much greater capability than ultrasonography to identify endometrial polyps. CONCLUSION: Sonohysterography may be used to complement ultrasonography and to substitute hysteroscopy, for the diagnosis of alterations that result in abnormal uterine bleeding.

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Most cited references 16

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Comparison of saline infusion sonography with office hysteroscopy for the evaluation of the endometrium.

Tammy Collins, Denis A Mitchinson, T Widrich … (1996)

Intrauterine infusion of saline solution during transvaginal ultrasonography enhances visualization of the endometrium. We compared the accuracy and pain rating of saline infusion sonography with those of flexible office hysteroscopy. The uterine cavities of 130 patients with abnormal bleeding were evaluated by two physicians in an office setting. Findings of endometrial polyps, submucous myomas, synechiae, endometrial hyperplasia, or cancer were recorded independently and subsequently compared. Patients rated their pain after each procedure. Both procedures were performed in 113 of 130 patients. With saline infusion sonography pathologic findings were identified in 61 patients (54%). For all findings combined, sensitivity was 0.96 and specificity was 0.88, compared with hysteroscopy. The results of saline infusion sonography and hysteroscopy did not differ significantly (p = 0.18). The former was less painful for patients than hysteroscopy (p < 0.0001). Saline infusion sonography is an accurate and well-tolerated method to evaluate abnormal uterine bleeding, compared with hysteroscopy.