7 Comparison of Two-Dimensional (2d) Transvaginal Ultrasound, Three-Dimensional (3d) Ultrasound and Hysteroscopy to Diagnose in Patients with Abnormal Uterine Bleeding

Introduction and aims of the study: Abnormal uterine bleeding (AUB) is defined as irregularity of menstrual bleeding in terms of amount, duration and frequency. It affects the quality of life in about 30% of women, is responsible for 70% of outpatient clinic applications and 25% of gynecological operations among perimenopausal and postmenopausal patients. The aim of the study is comparing the accuracy of two-dimensional (2D) transvaginal ultrasonography, three-dimensional (3D) ultrasonography and hysteroscopy with gold standard histopathology. Methods: Fifty patients (n = 50) between ages of 20-52 and with abnormal uterine bleeding complaint were included in the study. Three diagnostic methods were applied. During hysteroscopy, endometrial sample was taken from all patients and evaluated histopathologically. Negative predictive value, positive predictive value, sensitivity and specificity of the methods were calculated according to the histopathology. Results: The applying complaint of 72% participants was menorrhagia. Endometrial polyp was detected in 58% by TVUSG, 80% by 3D USG and 68% by hysteroscopy. Histopathologically, 70% of the patients had endometrial polyp. The second most common pathology was myoma uteri. While the sensitivity of detecting pathology with TVUSG was 65.85%, it was 97.56% with 3D USG and 78.04% with hysteroscopy. While TVUSG demonstrated 65.71% sensitivity in detection of endometrial polyp, 3D USG had 80% and hysteroscopy had 77.77% of accuracy. Hysteroscopy showed 100% sensitivity and specificity in detecting myoma uteri. Conclusions: Two-dimensional transvaginal ultrasonography is considered as the initial modality for diagnosis, new three-dimensional ultrasound technology has achieved high sensitivity and it has been observed that it is a guide to prevent unnecessary invasive procedures and to determine the correct hysteroscopic method before invasive procedure. 3D ultrasonography can be an initial modality in the diagnosis of many gynecologic diseases and an option before surgery.