{"paper_id":"35e4a0ea-090c-49ef-8dca-e768246490a0","body_text":"Orginal Article  | JOGCR. 2026; 11(5): 394-400 \n     Volume 11, May 2026       Journal of Obstetrics, Gynecology and Cancer Research \n Journal of Obstetrics, Gynecology and Cancer Research | ISSN: 2476-5848 \n \n \nDiagnostic Accuracy of Office Hysteroscopy and Three-Dimensional \nTransvaginal Ultrasonography in Women with Abnormal Uterine Bleeding \n \nMohamed El Mahy, Sherif Hamada *, Magdy Ibrahim, Yomna Ali Bayoumi, Abdullah Sayed, Heba M. \nHawas, Nada H. Eisa \n \nDepartment of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt  \nArticle Info  ABSTRACT \n  \n 10.24200/jogcr.11.5.394 \n \n \n \nBackground & Objective:  Abnormal Uterine Bleeding (AUB) is a common \ngynecological complaint with multiple underlying causes, including structural uterine \nabnormalities. Accurate, minimally invasive diagnostic tools are essential for \nidentifying intrauterine lesions and guiding appropriate management. The present study \nwas conducted with aim to evaluate the diagnostic agreement between office \nhysteroscopy and three -dimensional transvaginal ultrasonography (3D TVS) in \ndetecting intrauterine pathology among women presenting with AUB. \nMaterials & Methods: This cross -sectional analytic study was conducted at the \nDepartment of Obstetrics and Gynecology, Kasr Al -Ainy Medical Hospital, Cairo \nUniversity, from June 2021 to April 2023. Eighty women with AUB were evaluated \nusing 3D TVS followed by office hysteroscopy. Findings from both modalities were \nrecorded and compared for diagnostic correlation. Statistical analysis was performed \nusing IBM SPSS (version 22.0). P<0.05 was considered statistically significant. \nResults: The mean age of participants was 28.6±8.8 years and mean BMI was 29.9±6.3 \nkg/m². Menorrhagia was the most common bleeding pattern (52.3%). Office \nhysteroscopy detected endometrial polyps in 38.3%, thickened endometrium in 14.1%, \nand fibroids in 12.8%, while 3D TVS identified polyps in 23.0%, fibroids in 14.1%, and \nadenomyosis in 11.5%. Diagnostic concordance between the two methods was highest \nfor fibroids (71.4%) and niches (100%), while adenomyosis was detected only by 3D \nTVS. \nConclusion: Both office hysteroscopy and 3D TVS are effective for evaluating \nintrauterine pathology in AUB. Hysteroscopy remains the gold standard for focal \nlesions, whereas 3D TVS offers a reliable, noninvasive alternative with added value in \ndetecting myometrial abnormalities. \nKeywords: Abnormal uterine bleeding , Office hysteroscopy, Three -dimensional \ntransvaginal ultrasonography endometrial polyp , Fibroid, Adenomyosis, \nDiagnostic accuracy \n \nReceived: 2025/10/28 \nAccepted: 2025/12/16 \nPublished Online: 07 Apr. 2026 \n \n \n \n \n \nCorresponding Information:  \nSherif Hamada, \nDepartment of Obstetrics and Gynecology, \nFaculty of Medicine, Cairo University, Cairo, \nEgypt  \n \nEmail: Dr.Sherifkamal90@gmail.com \n \n \nCopyright © 2025, This is an original open -access article distributed under the terms of the Creative Commons Attribution-noncommercial \n4.0 International License which permits copy and redistribution of the material just in noncommercial usages with proper citation . \n \n \n1. Introduction\nAbnormal Uterine Bleeding (AUB) represents one of \nthe most common reasons for gynecological \nconsultations among peri - and postmenopausal \nwomen, accounting for approximately 15% of all \ngynecologic visits (1). AUB is defined as uterine \nbleeding with abnormal duration, frequency, or volume \nadversely affecting a woman’s Quality of Life (QoL) \nand psychological well-being (2). \nThe subjective perception of bleeding severity by \nwomen plays a crucial role in assessing the impact of \nAUB on QoL. However, self -reported bleeding often \ndiffers from objectively measured blood loss (3). \nMunro et al. , Reported that menstrual bleeding \nexceeding 80 mL, as well as any intermenstrual or \npostcoital bleeding, should be considered abnormal (4). \nHowever, 14% of women with mild to moderate \nbleeding perceive it as heavy, while 40% of those with \nobjectively excessive bleeding regard it as normal. \nPictorial Blood Assessment Charts can provide a \nsemiquantitative evaluation of bleeding severity (2). \nGiven that AUB may indicate underlying \nendometrial pathology including polyps, submucous \nmyomas, endometrial hyperplasia, or carcinoma \nappropriate diagnostic evaluation is essential, even \nwhen systemic, iatrogenic, or hormonal causes are \nsuspected (1). Transvaginal Ultrasonography (TVS) \nserves as a rapid, non -invasive, and cost -effective \ndiagnostic method to evaluate uterine structure, detect \nfibroids, adenomyosis, and assess endometrial \n\n\n395 Diagnostic Accuracy of Hysteroscopy vs 3D TVS in AUB \n      Volume 11, May 2026       Journal of Obstetrics, Gynecology and Cancer Research \nthickness and morphology, including endo-myometrial \ninterface (5). \nOffice Hysteroscopy (OH) with high diagnostic \naccuracy for various intrauterine abnormalities allows \ndirect visualization of uterine cavity and enables \ntargeted sampling of suspected lesions (6). \nTechnological advancements have established OH as a \nminimally invasive outpatient procedure, replacing \nblind intrauterine interventions under general \nanesthesia. This approach reduces complications, \nfacilitates faster recovery, and minimizes healthcare \ncosts by avoiding more invasive hospital -based \nprocedures (7). Moreover, integration of diagnostic and \noperative hysteroscopy into a single “see -and-treat” \nsession allows simultaneous evaluation and \nmanagement without cervical dilation or anesthesia \n(6). \nThe present study was conducted with aims to assess \nthe diagnostic agreement between office hysteroscopy \nand Three-Dimensional (3D) transvaginal \nultrasonography in women with AUB. \n \n2. Materials and Methods \nThis cross-sectional analytic study was conducted on \n80 women presenting with AUB at the Department of \nObstetrics and Gynecology, Kasr Al -Ainy Medical \nHospital, Cairo University, between June 2021 and \nApril 2023. Participants were selected from those \nattending the outpatient gynecology clinic during the \nstudy period. Women of reproductive or \nperimenopausal age presenting with AUB were eligible \nfor inclusion. Exclusion criteria included \nhemodynamic instability, severe chronic anemia due to \nprolonged bleeding , known coagulation or bleeding \ndisorders, cervical lesions or cervical malignancy, and \npregnancy. Virgins were also excluded to avoid \ninvasive procedures incompatible with their clinical \ncondition. \nAll participants underwent a standardized evaluation \nincluding comprehensive history taking, detailed \nclinical examination, and routine laboratory \ninvestigations. History taking encompassed \ndemographic data, menstrual history, medical and \nsurgical history,  and relevant family history. Clinical \nexamination involved a general assessment of the \npatient’s condition, measurement of height and weight \nfor Body Mass Index (BMI) calculation, and evaluation \nof pulse rate and blood pressure. Abdominal \nexamination included inspection for scars or distention \nand palpation to detect organomegaly or masses. Pelvic \nexamination was performed in the lithotomy position \nusing a Cusco s peculum to inspect the cervix and \nvaginal walls, followed by bimanual palpation to assess \nuterine size, shape, and mobility, as well as adnexal \ntenderness or masses. Routine laboratory \ninvestigations included a Complete Blood Count \n(CBC) and coagulation pr ofile to exclude systemic \ncauses of bleeding. \nTransvaginal ultrasonography was performed for all \nsubjects. Two -Dimensional (2D) Transvaginal \nUltrasonography (TVS) was first performed using a \nGeneral Electric (GE) Logic 200 ultrasound machine \nequipped with a 6.5 MHz transvaginal probe. The \nexamination was performed in a low lithotomy \nposition, and the uterus and adnexa were evaluated for \nstructural abnormaliti es. Endometrial morphology, \nthickness, and contour were documented, with \nendometrial thickness greater than 14 mm considered \nabnormal. Any focal i ntrauterine lesions, such as \nendometrial polyps, submucous fibroids, or \nadenomyosis, were recorded. Subsequently, Three-\nDimensional (3D) transvaginal ultrasonography was \nperformed using the same ultrasound system equipped \nwith a 3D transvaginal probe. The 3D examination \naimed to confirm the findings observed in 2D TVS or \nto identify additional abnormalities not detected \npreviously. T he final diagnosis was based on the \ncomprehensive 3D ultrasonographic findings (9-12). \nOffice Hysteroscopy (OH) was also performed for all \nparticipants during the early proliferative phase of the \nmenstrual cycle (days 6 -10). The procedure was \nconducted in the outpatient hysteroscopy unit using a \nKarl Storz (Germany) rigid continuous -flow \npanoramic hysteroscope, 25 cm in length, with a 5 mm \nouter sheath and a 30° fiberoptic lens. Illumination was \nprovided by a Circon Acmi G71A/Germany 150W \nmetal halide light source. Uterine distension was \nachieved using saline or glycine solution under \nmanometric control, maintaining an intrauterine \npressure of 100 -120 mmHg. All patients received an \nintramuscular injection of nonsteroidal anti -\ninflammatory drugs (Voltarin 75 mg) 30 -60 minutes \nprior to the procedure for pain control. The \nvaginoscopic approach was employed without the use \nof a speculum or tenaculum. The hysteroscope was \ngently advanced under direct vision through the \ncervical canal into the uterine cavity. A panoramic \ninspection of the uterine cavity was performed, \nfollowed by detailed visualizati on of both tubal ostia \nand systematic assessment of the anterior, posterior, \nand lateral uterine walls. Any detected lesions, \nincluding endometrial polyps, submucous fibroids, or \ndiffuse or focal endometrial thickening, were recorded. \nThe primary outcome was the detection of uterine \nlesions using 3D transvaginal ultrasonography and \noffice hysteroscopy. Agreement between both \ndiagnostic modalities was analyzed to evaluate the \naccuracy of 3D TVS in identifying intrauterine \npathology and i ts potential to reduce the need for \nfurther operative interventions, particularly among \nhigh-risk surgical patients. \nAll data were coded, tabulated, and analyzed using \nIBM SPSS Statistics software (version 22.0) (IBM \nCorp., Chicago, USA, 2013) and Microsoft Excel \n2007. Descriptive statistics were applied for \nquantitative variables as mean± Standard Deviation \n(SD) and range, and for qualitative variables as \n\nMohamed El Mahy, et al. 396 \n      Volume 11, May 2026       Journal of Obstetrics, Gynecology and Cancer Research \nfrequencies and percentages. The Shapiro -Wilk test \nwas applied to assess normality of distribution. \nIndependent sample t -tests were used to compare \nquantitative variables with normal distribution between \nthe groups. The Chi -square test or Fisher’s exact test \nwas used for categorical variables, as  appropriate. \nP<0.05 was considered statistically significant. \n \n3. Results \nThe mean age was 28.6±8.8 years (range: 20 -60), \nmean BMI was 29.9±6.3 kg/m² (range: 20 -43), and \nmean parity was 2.1±2.0 (range: 0 -6). Menorrhagia \nwas the most frequent presentation (52.3%), followed \nby metrorrhagia (21.7%), menometrorrhagia (21.7%), \nand postmenopausal bleeding (6.4%), indicating that \nheavy cyclic bleeding was the predominant AUB type \n(Table 1). \nHysteroscopy detected pathology in 77.0% of cases. \nThe most frequent lesion was endometrial polyp \n(38.3%), followed by thickened endometrium (14.1%), \nfibroid (12.8%), niche (8.9%), and polyp with \nthickened endometrium (5.1%). No pathology was \nidentified in  23.0% of patients. Three -dimensional \nTVS detected lesions in 80.8% of patients, identifying \npolyps in 23.0%, thickened endometrium in 14.1%, \nfibroids in 14.1%, adenomyosis in 11.5%, and niches \nin 8.9%. Combined lesions were observed in 7.7%, \nwhile 19.2% s howed normal findings. Hysteroscopy \nyielded higher detection of focal endometrial lesions, \nwhereas 3D TVS better visualized myometrial \npathology (Table 2). \nAmong women with menorrhagia, hysteroscopy \ndetected polyps in 54.7% and 3D TVS in 34.8%. In \nmetrorrhagia, fibroids were the most frequent finding \nby hysteroscopy (60.0%) and 3D TVS (42.0%). In \nmenometrorrhagia, thickened endometrium was most \ncommon by hysteroscopy (48.0%), while both fibroids \nand thickened endometrium were equally detected by \n3D TVS (24.0%). In postmenopausal bleeding, \nhysteroscopy identified combined polyp with \nthickened endometrium in 81.6%, whereas 3D TVS \ndemonstrated thickened endometri um in 100%. \nHysteroscopy demonstrated greater sensitivity for \nfocal lesions, whereas 3D TVS better detected diffuse \nmyometrial involvement (Table 3). \nThe overall diagnostic agreement between \nhysteroscopy and 3D TVS was high. Polyps showed \n51.0% agreement between both modalities; fibroids \ndemonstrated 71.4% concordance; niches were \nidentical in all cases (100%). Thickened endometrium \nshowed 37.0% agreeme nt, while adenomyosis was \nidentified exclusively by 3D TVS in over half of cases \ninitially labeled as normal on hysteroscopy. Among \npatients with no hysteroscopic pathology, 3D TVS \ndetected additional abnormalities in 66.0%, primarily \nadenomyosis (Table 4). \n \n \nTable 1. Demographic and Clinical Characteristics of the Study Population (n=80) \nVariable Value \nAge (years) 28.6±8.8 (20-60) \nBMI (kg/m²) 29.9±6.3 (20-43) \nParity 2.1±2.0 (0-6) \nMenorrhagia 42(52.3%) \nMetrorrhagia 17(21.7%) \nMenometrorrhagia 17(21.7%) \nPostmenopausal bleeding 5(6.4%) \nValues are presented as mean ±standard deviation (range) or number (percentage). BMI=Body Mass Index. Percentages are calculated based on \nthe total study population (n=80). \n \n \n \n\n397 Diagnostic Accuracy of Hysteroscopy vs 3D TVS in AUB \n      Volume 11, May 2026       Journal of Obstetrics, Gynecology and Cancer Research \nTable 2. Diagnostic Findings by Office Hysteroscopy and 3D Transvaginal Ultrasonography (n=80) \nFinding Office Hysteroscopy n (%) 3D TVS n (%) \nPolyp 30.6(38.3) 18.4(23.0) \nNiche 7.1(8.9) 7.1(8.9) \nFibroid 10.2(12.8) 11.2(14.1) \nThickened endometrium 11.2(14.1) 11.2(14.1) \nAdenomyosis – 9.2(11.5) \nCombined lesions 4.1(5.1) 6.1(7.7) \nNo identifiable pathology 18.4(23.0) 15.3(19.2) \nValues represent the number of cases and corresponding percentages based on total n=80. Combined lesions refer to the coexistence of two or \nmore intrauterine abnormalities (e.g., polyp + fibroid ± adenomyosis). 3D TVS=Three-dimensional transvaginal ultrasonography. \n \n \nTable 3. Comparison of Office Hysteroscopy and 3D TVS Findings According to Bleeding Pattern \nBleeding Type Hysteroscopy n (%) 3D TVS n (%) \nMenorrhagia (n=42) Polyp 23 (54.7), Niche 4 (9.9), Thick \nendometrium 3 (7.4), None 12 (29.8) \nPolyp 15 (34.8), Adenomyosis 3 (7.4), Combined 6 \n(14.8), None 12 (29.8) \nMetrorrhagia (n=17) Fibroid 10 (60.0), Polyp 4 (24.0), None 3 \n(18.0) \nFibroid 7 (42.0), Adenomyosis 3 (18.0), Combined \n3 (18.0), None 3 (18.0) \nMenometrorrhagia \n(n=17) \nThick endometrium 8 (48.0), Polyp 3 \n(18.0), Niche 3 (18.0), None 3 (18.0) \nFibroid 4 (24.0), Thick endometrium 4 (24.0), Polyp \n3 (18.0), Niche 3 (18.0), Adenomyosis 3 (18.0) \nPostmenopausal (n=5) Polyp 1 (20.4), Polyp + Thick \nendometrium 4 (81.6) Thick endometrium 5 (100) \nPercentages are calculated within each bleeding type group. Combined findings indicate coexistence of multiple intrauterine abnormalities (e.g., \npolyp + fibroid or adenomyosis). None = No abnormality detected on either diagnostic modality. \n \nTable 4. Concordance Between Office Hysteroscopy and 3D TVS Findings (n=80) \nHysteroscopic Diagnosis Corresponding 3D TVS Finding(s) Concordance \n(%) \nPolyp (n=31) Polyp 16 (51.0), Thick endometrium 3 (10.2), Fibroid/Adenomyosis 3 \n(10.2), None 9 (30.6) 51 \nNiche (n=7) Niche 7 (100) 100 \nFibroid (n=10) Polyp + Fibroid 3 (31.0), Fibroid 7 (71.4) 71 \nThick endometrium \n(n=11) Polyp 3 (28.0), Fibroid 4 (37.0), Thick endometrium 4 (37.0) 37 \nCombined lesions (n=4) Thick endometrium 4 (100) 100 \nNo pathology (n=18) Combined 3 (17.0), Adenomyosis 9 (51.0), None 6 (34.0) 34 \nConcordance (%) indicates the proportion of identical findings between 3D TVS and hysteroscopy within each diagnostic category. Combined \nfindings refer to overlap of structural lesions identified by both methods. “None” indicates cases where both diagnostic methods failed to identify \nintrauterine pathology. Percentages are rounded to one decimal point for clarity \n \n \n4. Discussion \nAccurate evaluation of the uterine cavity is \nfundamental in identifying correctable causes of AUB. \nStructural intrauterine lesions such as endometrial \npolyps, submucous fibroids, and endometrial \nthickening significantly contribute to AUB and are \noften amenable to minimally invasive treatment once \nidentified (9). The selection of precise, reproducible, \nand accessible diagnostic modalities is crucial for \nappropriate management. \nThe purpose of the present study was to compare the \ndiagnostic performance of office hysteroscopy and \n\nMohamed El Mahy, et al. 398 \n      Volume 11, May 2026       Journal of Obstetrics, Gynecology and Cancer Research \nThree-Dimensional Transvaginal Ultrasonography (3D \nTVS). Both methods were evaluated for their ability to \ndetect intrauterine lesions and thereby minimize \nunnecessary surgical intervention, particularly among \nsurgically high -risk patients. The mean age of \nparticipants in this study was 28.6±8.8 years, the mean \nBMI was 29.9±6.3 kg/m², and the mean parity was \n2.1±2.0. These findings are consistent with similar \nstudies in which participants presented with AUB \nduring the reproductive or perimenopausal period. \nNafad et al. , (2022) (1) reported a mean age of \n49.4±1.22 years and parity of 3.12±1.6, while Ahmed \net al., (2022) (13) and De Franciscis et al., (2019) (14) \nreported mean ages of 43.5±6.12 and 49.6±4.2 years, \nrespectively. Similarly, Mohammad et al. , (2018) \nfound a mean age of 36.5±9.57 years, BMI of \n29.47±4.24 kg/m², and parity of 1.68±2.11, aligning \nwith the present data (15). \nIn the present study, menorrhagia was the \npredominant bleeding pattern, occurring in 52.3% of \nwomen, followed by metrorrhagia (21.7%), \nmenometrorrhagia (21.7%), and postmenopausal \nbleeding (6.4%). Nafad et al. , (2022) (1) also reported \nmenorrhagia as the most frequent presentation (31%), \nconsistent with findings of other studies which noted \ncomparable distributions of bleeding types among \nwomen with AUB (16,17). \nIn the present study, hysteroscopy identified \nendometrial polyps as the most common finding \n(37.5%), followed by thickened endometrium (13.8%), \nfibroids (12.5%), and niches (8.8%). Combined lesions \nwere noted in 5%, and no abnormalities were observed \nin 22.5%. These results are concordant with reports that \nestablish hysteroscopy as the most sensitive tool for \nendometrial evaluation (15,16). \nAs the results of the present study showed, Three -\ndimensional TVS also revealed endometrial polyps as \nthe predominant lesion (22.5%), followed by thickened \nendometrium (13.8%), fibroids (13.8%), adenomyosis \n(11.3%), and niches (8.8%). Combined lesions, \nincluding polyp with fibroid or adenomyosis, were \nidentified in 7.6%, and 18.8% had normal findings. The \ndetection of adenomyosis by 3D TVS, which was not \nobserved in hysteroscopy, underscores its advantage in \nassessing myometrial pathology. When comparing \nboth modalities, 3D TVS missed 12 cases of \nendometrial polyps that were visualized by \nhysteroscopy, suggesting that while 3D TVS offers \nnoninvasive structural evaluation, hysteroscopy \nremains the reference method for direct visualization of \nintrauterine path ology. This observation aligns with \nAggarwal and Mishra (2022), who reported that \nhysteroscopy identified 65 cases (32.5%) with \nabnormalities compared to 40 (20%) by 3D TVS, with \n13 missed cases of polyps (16). Similarly, Mohammad \net al., (2018) found that 3D TVS detected abnormalities \nin 82% compared to 92% with hysteroscopy, \nreinforcing hysteroscopy’s higher diagnostic accuracy \nfor endometrial lesions (15). \nSeveral studies have compared the diagnostic \naccuracy of 3D TVS with hysteroscopy. Van den \nBosch (2010) reported 93% diagnostic accuracy for 3D \nTVS, with 96% sensitivity and 91% specificity in \ndetecting uterine cavity lesions among women with \nAUB (18). Balen et al., (2010) confirmed that both 3D \nTVS and hysteroscopy accurately identified polypoid \nintrauterine structures, with near-perfect sensitivity and \nspecificity (19). Conversely, Loverro et al. , (2001) \nreported 84.5% sensitivity and 98.7% specificity fo r \nsonography compared to hysteroscopy, with a positive \npredictive value of 98.0% (20). Collectively, these \nfindings confirm the diagnostic utility of 3D TVS while \nemphasizing that hysteroscopy remains the gold \nstandard for confirming intrauterine lesions. \nThis study’s strengths include its cross -sectional \nanalytic design, use of two validated diagnostic \nmethods, and the absence of attrition during follow-up. \nAll 3D TVS examinations were performed by a single \nsonographer independent of the hysteroscopy operator, \nwho was blinded to imaging findings, thereby \nminimizing interobserver and intraobserver bias. This \nmethodological rigor ensured consistency and \nreliability of the diagnostic comparisons. However, \nsome limitations should be acknowledged. The \nrelatively small, single -center sample size limits the \ngeneralizability of the results. The absence of \nhistopathological confirmation as a diagnostic gold \nstandard restricted the ability to fully validate imaging \naccuracy. Additionally, vascular and hemodynamic \ncharacteristics of endometrial lesions were not assessed \nwith Doppler studies, which could have enhanced \ndiagnostic precision. Future multicentric studies with \nlarger cohorts and histopathological correlation are \nrecommended to substantiate these findings. \n \n5. Conclusion \nBoth office hysteroscopy and 3D TVS are valuable \ndiagnostic tools for evaluating intrauterine lesions in \nwomen with AUB. Hysteroscopy demonstrated \nsuperior detection of focal endometrial abnormalities, \nparticularly polyps, while 3D TVS was advantageous \nfor identifying adenomyosis and combined uterine \npathologies. Given its noninvasiveness and diagnostic \naccuracy, 3D TVS serves as a reliable preliminary \nassessment, whereas hysteroscopy remains the \ndefinitive diagnostic modality. \n \n6. Declarations \nAcknowledgments \nThe authors gratefully acknowledge the invaluable \nacademic support provided by Mahmoud M. Ali, \nITMO University, Saint Petersburg, Russia, and \nANCOVA for Clinical Research Solutions, Mansoura \nCity, El Dakahilia Governorate, Egypt and the new \nbranch in Saudi  Arbia (https://ancova-research.com/). \nTheir assistance encompassed comprehensive \n\n399 Diagnostic Accuracy of Hysteroscopy vs 3D TVS in AUB \n      Volume 11, May 2026       Journal of Obstetrics, Gynecology and Cancer Research \nliterature retrieval, methodological and statistical \nguidance, data management, and critical input during \nmanuscript preparation and revision. \n \nEthical Considerations \nThis study was conducted and reported in accordance \nwith the STROBE (Strengthening the Reporting of \nObservational Studies in Epidemiology) guidelines for \ncross-sectional studies to ensure methodological rigor, \ntransparency, and reproducibility (8). This study was \nreviewed and approved by the Research Ethics \nCommittee (REC), Faculty of Medicine, Cairo \nUniversity (Ethical Code: MD -237-2021). Written \ninformed consent was obtained from all participants \nprior to inclusion in the study. \n \nAuthors' Contributions \nAll authors contributed substantially to the \nconception and design of the study, data acquisition, \nanalysis, and interpretation. All authors participated in \ndrafting, revising, and approving the final version of \nthe manuscript and agree to be accountable f or all \naspects of the work. \n \nConflict of Interest \nThe authors declare that there are no conflicts of \ninterest related to this study. \n \nFund or Financial Support \nThis research received no specific grant from any \nfunding agency in the public, commercial, or not -for-\nprofit sectors. \n \n \n \n \n \n1. Nafad M, Zakaria AEM, Abdel Fattah A A. 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Balen FG, Allen CM, Gardener JE, Siddle NC, \nLees WR. 3 -dimensional reconstruction of \nultrasound images of the uterine cavity. Br J \nRadiol. 1993;66 (787):588–91. \n[doi:10.1259/0007-1285-66-787-588] \n20. Loverro G, Nappi L, Vicino M, Carriero C, \nVimercati A, Selvaggi L. Uterine cavity \nassessment in infertile women: comparison of \ntransvaginal sonography and hysteroscopy. Eur \nJ Obstet Gynecol Reprod Biol. 2001;100(1):67–\n71. [doi:10.1016/s0301-2115(01)00434-1] \n \n \nHow to Cite This Article:  \nEl Mahy M, Hamada Sh, Ibrahim M, Ali Bayoumi Y, Sayed A, M. Hawas H, et al. Diagnostic Accuracy of Office \nHysteroscopy and Three-Dimensional Transvaginal Ultrasonography in Women with Abnormal Uterine Bleeding . \nJ Obstet Gynecol Cancer Res. 2026;11(5):394-400. \nDownload citation:                             RIS | EndNote | Mendeley |BibTeX |","source_license":"CC0","license_restricted":false}