Comparison of 3-dimensional with 2-dimensional saline infusion sonohysterograms for the evaluation of intrauterine abnormalities

Objective. To compare 3-dimensional saline infusion sonohysterography (3DSIS) with 2-dimensional sonohysterography (2DSIS) using hysteroscopy and histologic diagnosis as the gold standard. Method. A retrospective analysis of all SIS examination performed between July 1, 2005 and April 30, 2007 in our gynecological sonographic unit. 2DSIS or 3DSIS sonographic techniques were used randomly. Management decisions and operative procedures were done by the referring provider. Patients that had diagnostic hysteroscopy and complete histologic evaluation were included. Concordance between the various assessment methods as well as sensitivity and specificity were compared between 2DSIS and 3DSIS. Student's t test and chi-square test were used for statistical analysis. p < 0.05 was considered statistically significant. Result. Of 804 patients that had SIS, 125 patients met the inclusion criteria. Patient median age was 48 (range 19-82). Also, 77 patients were premenopausal, and 48 patients were postmenopausal. Furthermore, 43 patients had 2DSIS and 82 patients had 3DSIS. 3DSIS was found to correlate with hysteroscopic findings more often than 2DSIS (p < 0.05). A trend for higher specificity of 3DSIS with the different uterine pathologies was seen, but it did not reach statistical significance. No difference in sensitivity of 3DSIS compared with 2DSIS was found for all pathologic diagnoses. Conclusion. 3DSIS correlated better with hysteroscopy than 2DSIS. Specificity for histologic diagnosis appears to be higher with 3DSIS compared with 2DSIS but larger-scale studies are needed to confirm this finding.