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Re: HissterosonographyFrom: dahmd@gate.netThu Sep 19 20:54:27 1996
In article SAVARIS@vortex.ufrgs.br writes:
>I read this situation about ultra-hysterography. I saw it and I have few The answer to whether or not sonohysterography is "as good" as hysterosalpingography (HSG) depends on what information you are trying to obtain from the study. If you are looking at the fimria, then sonohysterography is *not* as good as HSG. However, if you want to evaluate the endometrial cavity, then I would argue that sonohysterography is *better* than HSG. There are a number of papers that have compared sonohysterography with HSG or hysteroscopy or hysterectomy. Gaucherand et al (Journal of Clinical Ultrasound 1995; 23:339) found that sonohysterography had a 94% sensitivity and 98% specificity and was more effective than HSG for determining endometrial abnormalities (i.e. polyps and submucous fibroids). Goldstein studied 21 women with irregular bleeding and compared the two techniques, finding a strong correlation between the two (Am J Obstet Gynecol 1994; 170:565). Other similar articles include: Randolph et al. Fertil Steril 1986;46:828, and Syrop et al. Obstet Gynecol 1992; 79:1041, and Parsons and Lense, JCU 1993;21:87. There is an article on this technique coming out sometime soon in Contemporary Ob/Gyn. Anna Parsons, M.D. and I studied 53 patients with sonohysterography prior to hysterectomy (for a variety of indications blinded to the physician sonographer) and found 6 submucous fibroids, 4 endometrial polyps, 3 multiple polyps, 6 polyps and fibroids, 3 carcinomas, and 31 normal cavities. The sensitivity and specificity approached 100%. Others have confirmed this. Since this technique certainly *is* less painful than HSG, and since I can do it in the office quickly and cheaply and can often render a diagnosis "on the spot" I use it for many situations. Radiologists may not be as "in tune" to what we are looking for from a gynecologic standpoint, and may not think to evaluate the endometrial cavity as well as we do (my opinion). Recently, for example, I diagnosed a polyp in a patient with postmenopausal bleeding who developed the bleeding after taking conjugated estrogen 0.625mg and medroxyprogesterone acetate 2.5 mg daily for over 2 years. After hysteroscopic polypectomy she is free of bleeding for over 8 months. Other reasonable uses include evaluation of irregular pre-and peri-menopausal bleeding, locating IUDs, evaluation of the cavity prior to assisted reproductive techniques, evaluation of bleeding while on tamoxifen therapy, estimating the size of fibroids before operative hysteroscopy, and evaluation of recurrent pregnancy loss. When I saw it, it was claimed that it was less painfull than the HSG This is true. Out of over 200 of these, I have never had a patient do more than say "ouch" as I inserted the catheter past the internal os, or comment that they have a cramp as the saline is infused. Patients who have had prior HSG's are amazed that this technique is so relatively painless.
, but the main issue is about the fine ddetailsof the fimbrias and
>falopian tubes. I think that it may tell you that 1 tube is patent (when free fluid appears in the cul-de-sac) but I agree that it is not the method of choice for visualizing tubal pathology. Furthermore, it is a new release of and old method called pneumopelvigraphy, where air was injected inside the uterus to check permeability. I admit to complete ignorance of pneumopelvigraphy. See, reading my mail today was educational! Thanks, Ashley D. Ashley Hill, M.D. dahmd@gate.net Orlando, FL
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