Diagnostic Accuracy of Office Hysteroscopy and Three-Dimensional Transvaginal Ultrasonography in Women with Abnormal Uterine Bleeding

Background & Objective: Abnormal Uterine Bleeding (AUB) is a common gynecological complaint with multiple underlying causes, including structural uterine abnormalities. Accurate, minimally invasive diagnostic tools are essential for identifying intrauterine lesions and guiding appropriate management. The present study was conducted with aim to evaluate the diagnostic agreement between office hysteroscopy and three-dimensional transvaginal ultrasonography (3D TVS) in detecting intrauterine pathology among women presenting with AUB.Materials & Methods: This cross-sectional analytic study was conducted at the Department of Obstetrics and Gynecology, Kasr Al-Ainy Medical Hospital, Cairo University, from June 2021 to April 2023. Eighty women with AUB were evaluated using 3D TVS followed by office hysteroscopy. Findings from both modalities were recorded and compared for diagnostic correlation. Statistical analysis was performed using IBM SPSS (version 22.0). P<0.05 was considered statistically significant.Results: The mean age of participants was 28.6±8.8 years and mean BMI was 29.9±6.3 kg/m². Menorrhagia was the most common bleeding pattern (52.3%). Office hysteroscopy detected endometrial polyps in 38.3%, thickened endometrium in 14.1%, and fibroids in 12.8%, while 3D TVS identified polyps in 23.0%, fibroids in 14.1%, and adenomyosis in 11.5%. Diagnostic concordance between the two methods was highest for fibroids (71.4%) and niches (100%), while adenomyosis was detected only by 3D TVS.Conclusion: Both office hysteroscopy and 3D TVS are effective for evaluating intrauterine pathology in AUB. Hysteroscopy remains the gold standard for focal lesions, whereas 3D TVS offers a reliable, noninvasive alternative with added value in detecting myometrial abnormalities.