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Journal of Ultrasound in Medicine, Vol 14, Issue 1 1-6, Copyright © 1995 by American Institute of Ultrasound in Medicine
Transvaginal hysterosonography in the evaluation of small endoluminal masses
T. J. Dubinsky, H. R. Parvey, G. Gormaz and N. Makland
Department of Radiology, University of Texas-Houston Medical School 77026, USA.
Transvaginal sonography is highly sensitive for detecting endometrial mass
lesions, but it is nonspecific. Biopsies performed on patients with
abnormal findings seen on TVS often are negative. We performed transvaginal
hysterosonography prospectively on 48 consecutive patients with endometrial
thickness demonstrated on TVS to be between 5 and 10 mm to assess whether
this technique would be useful in the evaluation of such patients. TVHS is
a simple, painless technique that is performed by placing a small catheter
into the endometrial canal and infusing a small amount of saline solution
under sonographic visualization. Of 48 suspected lesions, TVHS confirmed
only 19 endoluminal masses: 11 fibroids and eight polyps. Polyps tended to
be homogeneously echogenic and to have a pedunculated attachment to the
uterine wall without interruption of the endometrial lining. Fibroids
showed more heterogeneous echogenicity and had a more sessile attachment.
Four patients in our series had false-negative biopsy results prior to
having had endometrial mass lesions depicted on TVHS. TVHS may prevent
unnecessary biopsies in those patients who appear to have abnormalities on
TVS. By depicting the nature of the attachment of endoluminal masses to the
uterine wall more clearly, TVHS also may help direct subsequent biopsy
procedures.
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