***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A study was conducted to compare transvaginal ultrasound ( TVS ) , saline infusion sonography ( SIS ) and outpatient hysteroscopy for examining the uterine cavity in women with postmenopausal bleeding and unscheduled bleeding on hormone replacement therapy ( HRT ) . Fourty Subjects agreed to undergo TVS , SIS and hysteroscopy in addition to endometrial sampling . The abnormalities detected by each imaging method were recorded together with the discomfort ( visual analogue scale ) . Thirty women completed all three imaging procedures . In 18 cases TVS suggested an abnormal cavity .  SIS  and  hysteroscopy  were of similar efficacy in clarifying the nature of this , and confirmed an abnormality in 12 cases ( 40 % ) . TVS was significantly less painful than the other procedures ( p < 0.001 ) .  SIS and hysteroscopy were associated with pain scores similar to endometrial sampling . These findings justify the need for a large r and omised trial of TVS , SIS , hysteroscopy and endometrial sampling , in order to develop the most appropriate strategy for investigating postmenopausal bleeding and unscheduled bleeding on HRT OBJECTIVES To determine the ability of transvaginal ultrasound , with or without saline infusion , to detect focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > 5 mm , and to determine the accuracy of conventional ultrasound , saline contrast sonohysterography and diagnostic hysteroscopy under general anesthesia to diagnose endometrial polyps , submucous myomas and uterine malignancy . DESIGN In a prospect i ve study , 105 women with postmenopausal bleeding and endometrium > 5 mm underwent conventional ultrasound examination and saline contrast sonohysterography . Diagnostic and operative hysteroscopy under general anesthesia was then performed . The presence of focally growing lesions and the type of lesion ( endometrial polyp , submucous myoma , malignancy or unclear focal lesion ) were noted at ultrasound examination and at hysteroscopy . RESULTS There was almost perfect agreement ( 96 % ) between saline contrast sonohysterography and hysteroscopy in the diagnosis of focally growing lesions .  Saline contrast sonohysterography and hysteroscopy both had a sensitivity of approximately 80 % with regard to diagnosing endometrial polyps ( false-positive rates of 24 % and 6 % , respectively ) , whereas conventional ultrasound missed half of the polyps ( sensitivity , 49 % ; false-positive rate , 19 % ) .  Hysteroscopy  was superior to both saline contrast sonohysterography and conventional ultrasound with regard to discriminating between benign and malignant lesions ( sensitivity , 84 % , 44 % , and 60 % ; false-positive rate , 15 % , 6 % and 10 % , respectively ) . The risk of malignancy was increased seven-fold ( odds ratio , 7.3 ; 95 % confidence interval , 1.9 - 27.8 ) in women with distension difficulties at saline contrast sonohysterography , and two thirds of the women with a poorly distensible uterine cavity had a malignant diagnosis . CONCLUSION Saline contrast sonohysterography is as good as hysteroscopy at detecting focally growing lesions in the uterine cavity in women with postmenopausal bleeding . However , neither hysteroscopy nor saline contrast sonohysterography can reliably discriminate between benign and malignant focal lesions . Distension difficulties at saline contrast sonohysterography should raise a suspicion of malignancy Objective To assess the usefulness of transabdominal sonohysterography in the diagnosis and evaluation of submucous myomas . Methods Fifty-two premenopausal women hospitalized for hysterectomy for benign gynecologic indications under-went preoperative conventional transvaginal sonography , transabdominal sonohysterography , and hysteroscopy .  The results of the three techniques in terms of diagnosis , size , intracavitary growth , and location of the submucous myomas were compared with those revealed by direct inspection of the surgical specimens . Results Conventional transvaginal sonography for the diagnosis of submucous myomas had a sensitivity of 90 % and a specificity of 98 % ; the predictive values of abnormal and normal scans were 90 and 98 % , respectively . Transabdominal sonohysterography had sensitivity , specificity , and predictive values of 100 % , as did hysteroscopy . In all cases , the sonographic techniques measured tumor size more accurately than did hysteroscopy . The transabdominal sonohysterography measurements differed from direct evaluation by no more than 2 mm , and the hysteroscopic measurements were significantly different from those of the surgical specimens . The sonohysterographic evaluation of intrauterine growth was significantly more precise than that of the other techniques , differing from direct measurements by no more than 5–10 % . Conventional transvaginal sonography failed to localize three of 11 myomas ; hysteroscopy and  transabdominal sonohysterography provided the exact location in all cases . Conclusion Transabdominal sonohysterography is the most accurate technique for detecting submucous myomas and evaluating their size , intracavitary growth , and location STUDY OBJECTIVE To determine the validity of tissue sampling accomplished by hysteroscopically targeted or blind biopsies in the assessment of  endometrial morbidity associated with tamoxifen treatment . DESIGN Retrospective , unr and omized study ( Canadian Task Force classification II-2 ) . SETTING Public hospital . PATIENTS One hundred seventy-six menopausal women who had an endometrial stripe of more than 4 mm on transvaginal ultrasonography . INTERVENTION Review of histopathologic reports of patients undergoing  hysteroscopy followed by targeted ( 94 samplings ) or blind ( 82 samplings ) endometrial biopsies . MEASUREMENTS AND MAIN RESULTS Histopathology was considered the reference test to assess endometrial morbidity , and correlates with hysteroscopic findings were made to evaluate the validity of the two sampling procedures . Overall , in 23 women ( 13.0 % ) tissue sample s were insufficient for pathologic evaluation . Functional or atrophic endometrium and cystic atrophy were found in 51 ( 28.8 % ) and 37 patients ( 21.0 % ) , respectively . Polyps , hyperplasias , and carcinomas were found in 38 ( 21.5 % ) , 19 ( 10.7 % ) , and 6 ( 3.3 % ) , respectively . Blind biopsies failed to detect 5 of 5 polyps and 33 of 37 cystic atrophies , and in 34.1 % of cases provided insufficient tissue for diagnosis ; however , no hyperplasias or carcinomas were undetected . All specimens collected under vision were pathologically evaluable ; 34 of 38 hysteroscopic reports of cystic atrophy were confirmed , and neither endometrial polyps nor hyperplasias and carcinomas were undetected . In distinguishing between normal and abnormal endometrium , hysteroscopy showed sensitivity and negative predictive value of 100 % regardless of sampling modality . We found better specificity ( 80.0 % vs 68.9 % ) and positive predictive value ( 68.9 % vs 43.7 % ) for hysteroscopic diagnosis when tissue was collected under vision compared with blind sampling . CONCLUSION In women taking tamoxifen , endometrial evaluation performed by blind sampling is safe in excluding hyperplasias or carcinomas . For complete underst and ing of tamoxifen-associated morbidity , hysteroscopy with sampling under vision has better diagnostic compliance Objective To examine the cost implication s of outpatient versus daycase hysteroscopy to the National Health Service , the patient and their employer Objectives To establish the accuracy of saline infusion hysterosonography in diagnosing uterine pathology when compared with outpatient hysteroscopy OBJECTIVE Our purpose was to compare the screening effectiveness and acceptability of transvaginal ultrasonography ( with sonohysterography if endometrial thickness was > 4 mm ) with office hysteroscopy . STUDY DESIGN This r and omized crossover study comprised 53 consecutive asymptomatic ( without vaginal bleeding ) postmenopausal patients with breast cancer who had taken tamoxifen ( 20 or 40 mg/day ) for at least 6 months . RESULTS Two patients had endometrial cancer ( 1 primary , 1 breast secondary ) , both detected only by transvaginal ultrasonography . Twenty-six patients had at least 1 polyp ( total 47 , all benign ) . The women who had polyps were not significantly different in their age , body mass , months of tamoxifen intake , or the cumulative dose . The sensitivity and specificity of transvaginal ultrasonography  were 85 % and 100 % , respectively . The corresponding values for office hysteroscopy were 77 % and 92 % . It was significant that more patients preferred  transvaginal ultrasonography to hysteroscopy ( P < .001 ) . CONCLUSION Transvaginal ultrasonography ( plus sonohysterography ) may be more effective and acceptable than  office hysteroscopy  for detecting endometrial abnormalities in women taking tamoxifen OBJECTIVE We conducted this prospect i ve study to evaluate saline contrast hysterosonography ( SCHS ) as a diagnostic modality for intrauterine lesions in comparison to hysteroscopy and endometrial biopsy . MATERIAL S AND METHODS We included 135 patients , of whom 70 presented with abnormal uterine bleeding and 65 with subfertility problems . All cases were examined with conventional transvaginal sonography and were further investigated with SCHS using saline as contrast medium , and finally hysteroscopy with endometrial biopsy that was used as the reference test . RESULTS SCHS revealed the presence of intrauterine pathology in 23 cases and failed in three ( 4.2 % ) . SCHS had a sensitivity of 94 % , a specificity of 71 % , a positive predictive value of 76 % and a negative predictive value of 95 % in the abnormal uterine group . In subfertile patients , SCHS revealed the presence of intrauterine pathology in 34 cases and had a sensitivity of 96 % , a specificity of 74 % , a positive predictive value of 79 % and a negative predictive value of 95 % . CONCLUSIONS We found that SCHS is an extremely accurate modality for the diagnosis of focal endometrial pathology , compared to diagnostic hysteroscopy The objective of this study was to assess the effectiveness of saline contrast sonohysterography ( SCSH ) as a first-line investigation for perimenopausal women with uterine bleeding . A total of 162 women were enrolled in a prospect i ve study . They underwent SCSH indicated for abnormal uterine bleeding . Patients with normal or atrophic endometrium were scheduled for diagnostic hysteroscopy or hormone therapy .  Patients with uterine cavity abnormalities were scheduled for surgery ( operative hysteroscopy or hysterectomy ) . A clinical follow-up was obtained for all the patients after SCSH .  Sonohysterographic findings were compared with pathological results .  SCSH was carried out in 159 patients . In all but one case , the procedure was well tolerated by the patients . There were no complications either during or after the examination . Surgical and pathological results were available in 109 cases . SCSH was highly sensitive and specific in the differentiation between women with intrauterine lesions and those with normal or atrophic endometrium ( 98.9 % and 76.4 % , respectively ) . SCSH was also accurate in the diagnosis of polyps and submucosal myomas ( sensitivity 87.8 and 89.6 % , specifically 90.7 and 95 % ) . SCSH and surgery displayed the same reliability in the measurement and the localization of the lesions .  SCSH  recognized endometrial cancer in only 40 % of cases . However , all these patients had abnormalities at sonohysterography which indicated a surgical exploration , leading to a zero false-negative rate . Saline contrast sonohysterography appears to be a reliable tool for the investigation of abnormal uterine bleeding in perimenopausal women . It can distinguish women who only require medical therapy from those who require surgery . The method is easy to learn , and is well tolerated by the patients OBJECTIVE Evaluate the feasibility and the value of hysterography , sonohysterography and hysteroscopy for investigation of abnormal uterine bleeding .  Method . Longitudinal blind study of thirty-eight patients consulting for abnormal uterine bleeding during pre- and post menopause . All patients underwent an hysterography and transvaginal sonohysterography  , in r and om order , followed by an hysteroscopy with histological sample . The results were compared with the histo-pathological examination that was used for reference diagnosis . Statistical study of sensitivity , specificity and Positive and Negative Predictive Value ( PPV-NPV ) of each investigation ; rate of agreement by the coefficient of Kappa . RESULTS The hysterography offers a PPV of 83 % and a NPV of 100 % . The interpretation errors were associated with the simple mucous hypertrophy interpreted as " hyperplasy " . The limits correspond to a contrast agent allergy . The sonohysterography had a VPP of 89 % and a VPN of 100 % . The false positive is due to the difficulties of distinguishing the clots from the polyps . The limits correspond to the difficulties of cervix catheterization ( 13 % ) . As regards the hysteroscopy , the VPP was 81.5 % and the VPN 
    Output:
    
This systematic review and meta- analysis shows that diagnostic hysteroscopy is both accurate and feasible in the diagnosis of intrauterine abnormalities