OP16.05: The accuracy of saline‐infusion sonohysterography guided biopsy versus endometrial office biopsy in diagnosing endometrial pathology

Abnormal Uterine Bleeding (AUB) above the age of 40 is a common complaint in gynecology. Endometrial Office Biopsy (EOB) is the primary method used to detect endometrial pathology. The objective of this study is to evaluate the effectiveness of three-Dimensional Saline Infusion Sonohysterography Guided Biopsy (3D SISHGB), as compared with EOB in diagnosing endometrial pathologies, (histological and anatomical) among peri-menopausal and post-menopausal women with abnormal uterine bleeding. It is an interventional study comparing two methods of screening for the detection of endometrial pathology. Women above the age of 40 with AUB and abnormal endometrium (thickness >4 mm, inhomogeneous indistinct margin or inconclusive) diagnosed by 2D and 3D Trans-Vaginal Ultrasound were eligible. All included women were offered EOB and 3D SISHGB. The diagnosis was categorized as, 1) physiological 2) benign polyp or sub-mucous fibroid, 3) hyperplasia/ cancer. The accuracy of the two methods was determined by the adequacy of the sample and by comparing the pathologic diagnosis obtained with the final diagnosis confirmed by hysteroscopy or hysterectomy. Out of 113 included women; 3D SISHGB was performed in 109 patients (4 were excluded due to cervical stenosis). Whereas, EOB was performed in 97 women (11 women did not show up and the catheter could not be introduced in 5 patients). Ninety three patients had both 3D SISHGB and EOB and were entered into our final data analysis. 3D SISHGB had significant higher sample adequacy (96%) compared to EOB (86%) (p = 0.039). All 29 (100%) Polyps and sub-mucous fibroids as confirmed by hysteroscopy/ hysterectomy were detected by 3D SISHGB, compared with only 3 (10.3%) cases detected by EOB, and that was statistically significant (p < 0.0001). 3D SISHGB is significantly superior to EOB in sample adequacy and in diagnosing endometrial pathology and should be used as the primary test for the evaluation of peri-menopausal and post-menopausal women with AUB.