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© 2004 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 23:1433-1440 • 0278-4297

The Clinical Value of 3-Dimensional Saline Infusion Sonography in Addition to 2-Dimensional Saline Infusion Sonography in Women With Abnormal Uterine Bleeding

Work in Progress

Cornelis D. de Kroon, MD, Leonie A. Louwé, MD, J. Baptist Trimbos, MD, PhD and Frank Willem Jansen, MD, PhD

Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands.

Address correspondence and reprint requests to Frank Willem Jansen, MD, PhD, Department of Gynecology, Leiden University Medical Center, K6-76, PO Box 9600, 2300 RC Leiden, the Netherlands. E-mail: f.w.jansen{at}lumc.nl.

Objective. To evaluate the clinical relevance of 3-dimensional saline infusion sonography (3D-SIS) in addition to conventional SIS in women with abnormal uterine bleeding suspected of having intrauterine abnormalities. Methods. All women suspected of having intrauterine abnormalities were eligible. Before 3D-SIS, conventional SIS was performed. The results of these techniques were compared with the "combined method reference standard" (hysteroscopy, endometrial sampling, and clinical follow-up in cases with normal SIS findings). Diagnostic characteristics (with 95% confidence intervals [CIs]) of 3D-SIS and SIS were calculated as well as their respective accuracy in evaluating the histologic nature, the intrauterine extension, and the location of intrauterine abnormalities. Moreover, the reliability ({kappa} value) and clinical relevance of 3D-SIS were assessed. Results. A total of 49 women were included, and 4 women were excluded. The positive predictive values of 3D-SIS and SIS were, respectively, 1.00 and 0.86 (95% CI, 0.72–0.99; P = .15), and the diagnostic accuracy values were 0.98 (95% CI, 0.94–1.0) and 0.91 (95% CI, 0.83–0.99; P = .08). Saline infusion sonography and 3D-SIS were equally accurate in evaluating the histologic nature, intrauterine extent, and location of intrauterine abnormalities (respective {kappa} values: 0.85 versus 0.93; P = .88; 0.83 versus 0.83; and 0.77 versus 0.80; P = .81). The reliability of 3D-SIS was good: intraobserver and interobserver agreement ({kappa}) were 0.78 and 0.72. Three women (6.7%) had the benefit of additional 3D-SIS: in these women, SIS wrongly led to a diagnosis of intrauterine abnormalities (P = .08). Conclusions. Three-dimensional saline infusion sonography is valid and reliable in women suspected of having intrauterine abnormalities and may indeed have relevant clinical value in addition to conventional SIS.

Key Words: intrauterine abnormalities • reliability • saline infusion sonography • 3-dimensional saline infusion sonography • 3-dimensional sonography • validation

Abbreviations: CI, confidence interval • SIS, saline infusion sonography • 3D, 3-dimensional • TVS, transvaginal sonography




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