DIAGNOSTIC ACCURACY OF HYSTEROSONOGRAPHY AGAINST TRANSVAGINAL ULTRASOUND IN DIAGNOSIS OF ENDOMETRIAL LESIONS IN PATIENTS PRESENT WITH ABNORMAL UTERINE BLEEDING TAKING HYSTEROSCOPY AS GOLD STANDARD

Objective:  To evaluate the diagnostic accuracy of hysterosonography against transvaginal ultrasound in diagnosis of uterine lesions by taking hysteroscopy as gold standard. Design: Cross sectional study Patients and Methods : This study was conducted in Department of Radiology, at Bolan Medical Complex Hospital, Quetta from 1 st July 2018 to 30 th April 2019. Women presented with history of abnormal uterine (AUB) bleeding were included in this study. Pregnancy was ruled out by transabdominal scan. Transvaginal ultrasound and hysterosonography were performed in all the patients. All the data were coded and analyzed using SPSS version 21. Results:  446 patients who underwent transvaginal ultrasound (TVUS), hysterosonography (HSG), and hysteroscopy as part of their gynecological investigations. For Endometrial Polyps, TVUS shows sensitivity 60.53%, specificity 97.06%, positive predictive value (PPV) 95.83%, and negative predictive value (NPV) 68.75% while HSG shows sensitivity 95%, specificity 97.14%, PPV 97.44%, and NPV 94.44%. For Submucous Leiomyoma, TVUS shows sensitivity 57.14%, specificity 93.48%, PPV 84.21%, and NPV 78.18% while HSG shows sensitivity 96.55%, specificity 100.00%, PPV 100.00%, and NPV 97.92%. Conclusion: Diagnostic efficacy of HSG is superior to TVUS for the diagnosis of endometrial polyps and submucous fibroids. HSG should be considered as an intermediate investigation after TVUS to assess intracavity pathology and to confirm the diagnosis; hysteroscopy should become a therapeutic intervention. Keywords: Hysterosonography (HSG), Transvaginal ultrasound (TVUS), Uterine Lesions, Abnormal Uterine bleeding.