Office hysteroscopy, transvaginal ultrasound and endometrial histology: a comparison in infertile patients

Objective. To evaluate accuracy of transvaginal sonography (TVS) and hysteroscopy in detection of intrauterine pathology in infertile women. Subjects and methods. This retrospective study was conducted in 56 infertile women with abnormal transvaginal ultrasound findings of the uterine cavity which was performed during the midfollicular phase as a part of routine infertility workup. Hysteroscopy was performed between 6th and 10th day of cycle. Results. The mean age of the subjects was 31.9±4.0. The most frequent ultrasound finding was endometrial polyp in 34 (60.7%) patients, septate uterus in 8 (14.3%) patients, submucosal myoma in 7 (12.5%) patients, endometrial hyperplasia in 5 (8.9%) patients and Syndroma Ascherman in 2 (3.6%) patients. Hysteroscopy confirmed 20 (35.7%) polyps, the same number of myomas, septate uterus and Syndroma Ascherman as detected by ultrasound, (7 (12.5%), 8 (14.3%) and 2 (3.6%), respectively) and 19 (33.9%) endometrial hyperplasia. In 46 women with histological excamination, the sensitivity of TVS and hysteroscopy in the diagnosis of endometrial polyps were identical - 100%, while the specificity was higher in hysteroscopy than in TVS (92.3% versus 56.4%, p<0.001). The sensitivity of TVS in the diagnosis of endometrial hyperplasia was higher than that of hysteroscopy (86.4% versus 22.7%, p<0.001), while specificity was identical, of 100%. Accordance between hysteroscopy and histology was good (k=0.79), between ultrasound and histology was moderete (k=0.59). Conclusion. Hysteroscopy appeared to be more reliable in diagnosis than TVS. The use of a high frequency ultrasound probe leads us to a lack of diagnostic clarity between endometrial polyps and hyperplasia.