General Gynecology

Archives of Gynecology and Obstetrics

, Volume 284, Issue 1, pp 111-117

First online:

Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy in postmenopausal bleeding

  • Banu BingolAffiliated withIVF Center, Gayrettepe Florence Nightingale Hospital, Istanbul Bilim University
  • , M. Ziya GunencAffiliated withDepartment of Obstetrics and Gynecology, Istanbul Maltepe University
  • , Ali GedikbasiAffiliated withDepartment of Obstetrics and Gynecology, Istanbul Bakirkoy Maternity and Children Diseases Hospital Email author 
  • , Haldun GunerAffiliated withDepartment of Obstetrics and Gynecology, Gazi University
  • , Seval TasdemirAffiliated withFertigyn, IVF Center
  • , Bulent TirasAffiliated withDepartment of Obstetrics and Gynecology, Gazi University

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To compare the diagnostic accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) with respect to pathological diagnosis in the detection of uterine cavity abnormalities associated with abnormal uterine bleeding among postmenopausal women.


Being a prospective, investigator-blind trial, the present study was conducted on 137 postmenopausal women, with abnormal uterine bleeding, admitted to the Department of Obstetrics and Gynecology of Istanbul Bilim University, Florence Nightingale Hospital and Fertigyn Woman Health and IVF Center. After TVS, all patients underwent SIS using Cook Soft 500 IVF transfer catheter and HS, consecutively. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated to compare the diagnostic accuracy of TVS, SIS and HS.


Most commonly encountered endometrial lesions were polypoid lesion (38.0%) and hyperplasia (28.4%) among our study population consisting of 137 women (mean age 61.6 ± 9.6 years) in their postmenopausal stage. Overall sensitivity rates were 70.0% for TVS, 89.6% for SIS and 92.3% for HS, while the overall specificity rates were 50.0, 77.3 and 80.7%, respectively. HS had PPV of 96.2% and NPV of 65.3%, whereas PPV was determined to be 80.9 versus 95.3% and NPV was 35.4 versus 58.3% for TVS and SIS, respectively.


As an easy to perform, safe and well-tolerated procedure yielding high diagnostic accuracy, saline infusion SIS via this catheter seems to be superior to TVS and very close to HS. It may be used as the primary method for the detection of uterine abnormalities among postmenopausal women with abnormal uterine bleeding.


Transvaginal sonography Saline infusion sonohysterography Hysteroscopy Postmenopausal bleeding Uterine cavity Diagnostic accuracy