The accuracy of endometrial biopsy and saline sonohysterography in the determination of the cause of abnormal uterine bleeding

Objective: The purpose of this study was to determine the accuracy of outpatient endometrial biopsy and saline sonohysterography for the evaluation of abnormal uterine bleeding. Study Design: Eligible participants included women aged 25 to 69 years who complained of persistent uterine bleeding, despite medical treatment. One hundred forty-four patients consented and were followed up prospectively: 1 patient did not successfully complete a saline sonohysterography because of discomfort, 143 patients underwent an endometrial biopsy and saline sonohysterography as outpatients, 113 patients underwent a definitive surgical intervention (hysteroscopy/dilatation and curettage or hysterectomy), 20 patients did not complete a gold standard measure, and 10 patients were lost to follow-up. Results: The combination of endometrial biopsy and saline sonohysterography for the 113 patients who completed the study had a sensitivity and specificity for the detection of abnormal pathologic features of 97.0% (95% CI, 88.6-99.5) and 70.2% (95% CI, 55.0-82.2) and a positive and negative predictive value of 82.1% (95% CI, 71.4-89.5) and 94.3% (95% CI, 79.6-99.0) compared with hysteroscopy/curettage or hysterectomy. Conclusion: The high sensitivity and high negative predictive value of saline sonohysterography combined with endometrial biopsy make this technique useful for the evaluation of abnormal uterine bleeding. It may allow some patients to avoid more invasive operative procedures; however, it is important to recognize the limitations in the predictive value of this diagnostic modality. (Am J Obstet Gynecol 2002;186:858-60.)