Australian and New Zealand Journal of Obstetrics and Gynaecology 2003; 43: 448– 452 448 Blackwell Publishing Ltd. Original Article Sonohysterography Diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps Meltem NASS DUCE, 1 Utku ÖZ, 2 Caner ÖZER, 1 Altan YILDIZ, 1 Feramuz Demir APAYDIN 1 and Filiz ÇIL 2 Departments of 1 Radiology and 2 Obstetrics and Gynecology, Faculty of Medicine, Mersin University, Mersin, Turkey Abstract Aims: To evaluate the diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps. Methods: Thirty-two women whose preliminary transvaginal ultrasound suggested endometrial abnormality underwent sonohysterography. The findings were then compared with histopathological results. Results: The sonohysterographic diagnosis was fibroid in seven patients, endometrial polyp in 23 patients and simple hyperplasia in two patients. Histopathological findings confirmed our diagnosis in all except three patients with endometrial polyps, who had normal secretory endometrium. Sonohysterography was found to have a sensitivity of 100%, a positive predictive value of 90% and diagnostic accuracy of 90.6%. Conclusion: Sonohysterography is a useful, minimally invasive and accurate technique to evaluate the pathologies involving endometrium and uterine cavity. Key words: endometrial polyp, simple hyperplasia, sonohysterography, submucosal fibroid, transvaginal ultrasound. Introduction Transvaginal sonography (TVS) is a sensitive method for the evaluation of the uterine masses and abnormalities. However, the exact localisation of the lesion, relative to the uterine cavity, or the nature of the lesion cannot always be clearly assessed with TVS. Sonohysterography (SHG), however, is a simple, minimally invasive, and effective ultrasound procedure that can be used to evaluate these abnormalities. 1–3 Endometrial polyps and submucosal fibroids are two of the most common uterine pathologies, resulting in endometrial abnormalities or thickening. Detailed evaluation of these pathologies with SHG provides an enhanced transvaginal sonographic imaging and permits distinction between endometrial, submucosal and intramural lesions. 1,2,4 Methods In the present study, women whose initial TVS suggested the possibility of an endometrial or submucosal abnormality, were recommended SHG for further evaluation. On TVS, the endometrium was considered abnormal if there was focal or diffuse endometrial thickening, or focal or diffuse abnormal endometrial echos. The study group consisted of 32 women, 30 of whom were premenopausal. The chief complaints of the patients were abnormal uterine bleeding, pelvic pain, and infertility. All patients were examined with a Siemens Versa Plus scanner (Siemens AG, Erlangen, Germany) using a 6.5 MHz transvaginal probe. The ethics committee of the hospital of Mersin University approved the study. In premenopausal women, the SHG was carried out within the first 10 days of the menstrual cycle. As the postmeno- pausal women were not receiving any hormone replacement therapy, no special timing was needed. No preprocedural antibiotics, sedation or pain medications were used. A preliminary TVS was carried out with an empty blad- der immediately before SHG. The uterus and adnexa were evaluated and any abnormalities detected were recorded. Endometrial thickness was measured in the sagittal plane and at the widest point, and was considered to be thick if its measurement exceeded 12 mm in premenopausal women and 4 mm in postmenopausal women. The cervix was visualised using a self-retaining speculum and cleansed Correspondence: Dr Meltem Nass Duce, Mersin Üniversitesi, Tip Fakültesi Hastanesi Ihsaniye Mah. 123 Cad. 4931 Sok. TR-33079, Mersin, Turkey. Email: mnduce@mersin.edu.tr Received 25 May 2003; accepted 1 August 2003.