In-office saline infusion sonography advocated. (Abnormal Uterine Bleeding).

BALTIMORE -- Like hysteroscopy, saline infusion sonography should become a part of the office evaluation for abnormal bleeding, Dr. Linda Bradley said at a symposium on women's health sponsored by Mercy Medical Center.

Both saline infusion sonography (SIS) and hysteroscopy are highly accurate for detecting intracavitary lesions and are associated with "an extremely high patient satisfaction rate," said Dr. Bradley, director of hysteroscopic services at the Cleveland Clinic Foundation.

Rather than using one procedure to the exclusion of the other, they "play a complementary role in the evaluation of dysfunctional bleeding," she added.

In general, indications are no different than those for hysteroscopy and include evaluation of abnormal uterine bleeding; evaluation of women on tamoxifen; infertility evaluations; postoperative evaluation for uterine synechiae; and preoperative evaluation for endometrial ablation. It also can be used when evaluation of an abnormal endometrium by conventional transvaginal ultrasound is indeterminate.

Contraindications include pregnancy, cervical infections or cancer, excessive uterine bleeding, and suspected uterine cancer. Complications, which occur infrequently, include perforation, infections, pain, a missed diagnosis, or an interrupted pregnancy, Dr. Bradley noted.

With SIS, it is possible to visualize the adnexa and determine the size, number, location, and depth of penetration of fibroids. With hysteroscopy, the view is limited to the endometrial surfaces, and it is not possible to view the depth of myometrial involvement of uterine fibroids, although a global view of the endocervix and endometrium is possible and the cornua is easily visualized, she added.

When visualizing fibroids with hysteroscopy, one can often detect a ...