Comparison of Two- and Three-Dimensional Ultrasonography Versus Diagnostic Hysteroscopy for the Investigation of Abnormal Uterine Bleeding in Premenopausal Women

Objective: To compare two- and three-dimensionalultrasonography (2D- and 3D-US) versus diagnostic hysteroscopyfor the investigation of abnormal uterine bleeding inpremenopausal women.Design: A prospective observational cross-sectional study.Setting: Department of Obstetrics and Gynecology, KasrEl-Aini Hospital, Cairo University.Participants: 50 premenopausal women with abnormaluterine bleeding and suspected uterine lesions.Methods: 2D- and 3D-US followed by diagnostic hysteroscopy.The ultrasonographic and hysteroscopic findingswere compared to the histopathological findings.Main outcome measures: Accuracy of 2D- and 3D-USversus diagnostic hysteroscopy in the diagnosis of uterinelesions.Results: 3D-US was superior to 2D-US and hysteroscopyin the diagnosis of uterine lesions as shown by sensitivity,specificity, +ve predictive value, -ve predictive value, overallaccuracy, +ve likelihood ratio and -ve likelihood ratio of88.57%, 93.33%, 96.88%, 77.78%, 90.00%, 13.29 and 0.12respectively for 3D-US, compared to 65.71%, 86.67%, 92.00%,52.00%, 72.00%, 4.93 and 0.40 respectively for 2D-US, and71.43%, 93.33%, 96.15%, 58.33%, 78.00%, 10.71 and 0.31respectively for hysteroscopy.Conclusion: 3D-US can safely be used as the first lineinvestigation for abnormal uterine bleeding in premenopausalwomen. Hysteroscopy can be used as a second line investigation.