Skip to main content


Log in

3D sonohysterography vs hysteroscopy: a cross-sectional study for the evaluation of endouterine diseases

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript



To assess the concordance between the presumed diagnosis obtained with the 3D sonohysterography (SHG) and with the diagnostic hysteroscopy (HYS); to determine whether the 3D SHG has the accuracy needed to be considered as a diagnostic screening standard in cases of suspected endouterine pathology.


We selected 224 patients who voluntarily decided to undergo 3D SHG from a population with suspected presence of endouterine disease at TVS. The patients underwent first 3D SHG and then diagnostic HYS. We recorded each patient’s discomfort/pain during the two techniques. We used the “Bayes Theorem” to calculate the sensitivity and specificity of the 3D SHG as compared to HYS.


Overall the 3D SHG diagnosis was confirmed in 156/224 cases (69.64 %). Concordance for endometrial thickening was 0 %; for Asherman’s syndrome was 50.00 %; for polyp was 77.78 %; and for myoma, mucus accumulation and Müllerian anomalies (arcuate uterus, septate and subseptate uterus) was 100.00 %. Furthermore, 3D SHG was better tolerated than HYS.


Despite the diagnostic accuracy and mini-invasiveness of 3D SHG, we suggest that it cannot be a substitute of HYS in endouterine disease diagnosis, but it could be considered as a good method of screening to address patients to hysteroscopic confirmation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Dicker D, Goldman JA, Ashkenazi J, Feldberg D, Dekel A (1990) The value of hysteroscopy in elderly women prior to in vitro fertilization-embryo transfer (IVF-ET): a comparative study. J In Vitro Fert Embryo Transf 7:267–270. doi:10.1007/BF01129532

    Article  CAS  PubMed  Google Scholar 

  2. Gizzo S, Saccardi C, Di Gangi S, Bertocco A, Vendemiati L, Righetto L, Patrelli TS, D’antona D, Nardelli GB (2014) Secondary amenorrhea in severe Asherman’s syndrome: step by step fertility retrieval by Bettocchi’s hysteroscope: some considerations. Minim Invasive Ther Allied Technol 23:115–119. doi:10.3109/13645706.2013.835736

    Article  PubMed  Google Scholar 

  3. Negm SM, Kamel RA, Abuhamila FA (2012) Three-dimensional sonohysterography compared with vaginoscopic hysteroscopy for evaluation of the uterine cavity in patients with recurrent implantation failure in in vitro fertilization cycles. J Minim Invasive Gynecol 19:503–508. doi:10.1016/j.jmig.2012.03.021

    Article  PubMed  Google Scholar 

  4. Lee SI (2007) An imaging algorithm for evaluation of abnormal uterine bleeding: does sonohysterography play a role? Menopause 14:823–825. doi:10.1097/gme.0b013e318136e1c6

    Article  PubMed  Google Scholar 

  5. Farquhar C, Ekeroma A, Furness S, Arroll B (2003) A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Acta Obstet Gynecol Scand 82:493–504. doi:10.1034/j.1600-0412.2003.00191.x

    Article  PubMed  Google Scholar 

  6. de Kroon CD, Jansen FW (2006) Saline infusion sonography in women with abnormal uterine bleeding: an update of recent findings. Curr Opin Obstet Gynecol 18:653–657. doi:10.1097/01.gco.0000247395.32711.68

    Article  PubMed  Google Scholar 

  7. Metello J, Relva A, Milheras E, Colaço J, Retto H (2008) Hysteroscopic diagnostic accuracy in post-menopausal bleeding. Acta Med Port 21:483–488

    PubMed  Google Scholar 

  8. Gizzo S, Di Gangi S, Bertocco A, Noventa M, Fagherazzi S, Ancona E, Saccardi C, Patrelli TS, D’Antona D, Nardelli GB (2014) Levonorgestrel intrauterine system in adjuvant tamoxifen treatment: balance of breast risks and endometrial benefits—systematic review of literature. Reprod Sci 21:423–431. doi:10.1177/1933719113503408

    Article  CAS  PubMed  Google Scholar 

  9. Saccardi C, Gizzo S, Patrelli TS, Ancona E, Anis O, Di Gangi S, Vacilotto A, D’Antona D, Nardelli GB (2013) Endometrial surveillance in tamoxifen users: role, timing and accuracy of hysteroscopic investigation: observational longitudinal cohort study. Endocr Relat Cancer 20:455–462. doi:10.1530/ERC-13-0020

    Article  PubMed  Google Scholar 

  10. Abu-Ghazzeh Y, Shakoury WA, Barqawi R (1999) Comparative study of transvaginal hysterosonography and biopsy for the evaluation of post-menopausal bleeding. Ann Saudi Med 19:116–119

    CAS  PubMed  Google Scholar 

  11. Bradley LD (2002) Complications in hysteroscopy: prevention, treatment and legal risk. Curr Opin Obstet Gynecol 14:409–415

    Article  PubMed  Google Scholar 

  12. Fleischer AC (1999) Sonographic assessment of endometrial disorders. Semin Ultrasound CT MR 20:259–266. doi:10.1016/S0887-2171(99)90071-9

    Article  CAS  PubMed  Google Scholar 

  13. Davis PC, O’Neill MJ, Yoder IC, Lee SI, Mueller PR (2002) Sonohysterographic findings of endometrial and subendometrial conditions. Radiographics 22:803–816. doi:10.1148/radiographics.22.4.g02jl21803

    Article  PubMed  Google Scholar 

  14. Kowalczyk D, Guzikowski W, Więcek J, Sioma-Markowska U (2012) Clinical value of real time 3D sonohysterography and 2D sonohysterography in comparison to hysteroscopy with subsequent histopathological examination in perimenopausal women with abnormal uterine bleeding. Neuro Endocrinol Lett 33:212–216

    PubMed  Google Scholar 

  15. Erdem M, Bilgin U, Bozkurt N, Erdem A (2007) Comparison of transvaginal ultrasonography and saline infusion sonohysterography in evaluating the endometrial cavity in pre- and postmenopausal women with abnormal uterine bleeding. Menopause 14:846–852. doi:10.1097/gme.0b013e3180333a6b

    Article  PubMed  Google Scholar 

  16. Kamel HS, Darwish AM, Mohamed SA (2000) Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps. Acta Obstet Gynecol Scand 79:60–64. doi:10.1034/j.1600-0412.2000.079001060.x

    Article  CAS  PubMed  Google Scholar 

  17. Epstein E, Ramirez A, Skoog L, Valentin L (2001) Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium >5 mm. Ultrasound Obstet Gynecol 18:157–162. doi:10.1046/j.1469-0705.2001.00472.x

    Article  CAS  PubMed  Google Scholar 

  18. Soares SR, Barbosa dos Reis MM, Camargos AF (2000) Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases. Fertil Steril 73:406–411. doi:10.1016/S0015-0282(99)00532-4

    Article  CAS  PubMed  Google Scholar 

  19. WMA declaration of Helsinki (2013) Ethical principles for medical research involving human subjects. In: 64th WMA general assembly, Fortaleza, Brazil, October 2013

  20. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis PP, Glasziou PP, Irwig LM, Lijmer JG, Moher D, Rennie D, De Vet HC, Standards for Reporting of Diagnostic Accuracy (2003) Toward complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Standards for reporting of diagnostic accuracy. BMJ 326:41–44. doi:10.1136/bmj.326.7379.41

    Article  PubMed Central  PubMed  Google Scholar 

  21. Wolman I, Groutz A, Gordon D, Kupferminc MJ, Lessing JB, Jaffa AJ (1999) Timing of sonohysterography in menstruating women. Gynecol Obstet Invest 48:254–258. doi:10.1159/000010194

    Article  CAS  PubMed  Google Scholar 

  22. Bocca SM, Oehninger S, Abuhamad AZ (2008) Detection of transient postoperative changes in the endometrial cavity by 3-dimensional ultrasonography after hysteroscopic correction of various uterine anomalies. J Ultrasound Med 27:461–465

    PubMed  Google Scholar 

  23. (1988) The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril 49:944–955

  24. Khan F, Jamaat S, Al-Jaroudi D (2011) Saline infusion sonohysterography versus hysteroscopy for uterine cavity evaluation. Ann Saudi Med 31:387–392. doi:10.4103/0256-4947.83213

    Article  PubMed Central  PubMed  Google Scholar 

  25. Katsetos C, Radhakrishnan S, Koumousidis A, Kontoyannis M, Sanoulis V, Spaliaras D, Kouvelas S (2013) Comparison of transvaginal 3D sonohysterography with outpatient hysteroscopy in the evaluation of abnormal uterine bleeding. Clin Exp Obstet Gynecol 40:74–77

    CAS  PubMed  Google Scholar 

  26. Ludwin A, Pityński K, Ludwin I, Banas T, Knafel A (2013) Two- and three-dimensional ultrasonography and sonohysterography versus hysteroscopy with laparoscopy in the differential diagnosis of septate, bicornuate, and arcuate uteri. J Minim Invasive Gynecol 20:90–99. doi:10.1016/j.jmig.2012.09.011

    Article  PubMed  Google Scholar 

  27. Saidi MH, Sadler RK, Theis VD, Akright BD, Farhart SA, Villanueva GR (1997) Comparison of sonography, sonohysterography, and hysteroscopy for evaluation of abnormal uterine bleeding. J Ultrasound Med 16:587–591

    CAS  PubMed  Google Scholar 

Download references


The Authors are grateful to Irene Condemi for the language revision of the manuscript.

Conflict of interest

All Authors have no proprietary, financial, professional or other personal interest of any nature in any product, service or company. The Authors alone are responsible for the content and writing of the paper.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Antonio Simone Laganà.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Laganà, A.S., Ciancimino, L., Mancuso, A. et al. 3D sonohysterography vs hysteroscopy: a cross-sectional study for the evaluation of endouterine diseases. Arch Gynecol Obstet 290, 1173–1178 (2014).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: