***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: Objective To compare the diagnostic accuracy of transvaginal sonography ( TVS ) , saline infusion sonohysterography ( SIS ) and hysteroscopy ( HS ) with respect to pathological diagnosis in the detection of uterine cavity abnormalities associated with abnormal uterine bleeding among postmenopausal women . Methods Being a prospect i ve , investigator-blind trial , the present study was conducted on 137 postmenopausal women , with abnormal uterine bleeding , admitted to the Department of Obstetrics and Gynecology of Istanbul Bilim University , Florence Nightingale Hospital and Fertigyn Woman Health and IVF Center . After TVS , all patients underwent SIS using Cook Soft 500 IVF transfer catheter and HS , consecutively . Sensitivity , specificity , and positive and negative predictive values ( PPV and NPV ) were calculated to compare the diagnostic accuracy of TVS , SIS and HS . Results Most commonly encountered endometrial lesions were polypoid lesion ( 38.0 % ) and hyperplasia ( 28.4 % ) among our study population consisting of 137 women ( mean age 61.6 ± 9.6 years ) in their postmenopausal stage .  Overall sensitivity rates were 70.0 % for TVS , 89.6 % for SIS and 92.3 % for HS , while the overall specificity rates were 50.0 , 77.3 and 80.7 % , respectively . HS had PPV of 96.2 % and NPV of 65.3 % , whereas PPV was determined to be 80.9 versus 95.3 % and NPV was 35.4 versus 58.3 % for TVS and SIS , respectively . Conclusions As an easy to perform , safe and well-tolerated procedure yielding high diagnostic accuracy  , saline infusion SIS via this catheter seems to be superior to TVS and very close to HS . It may be used as the primary method for the detection of uterine abnormalities among postmenopausal women with abnormal uterine bleeding OBJECTIVE To compare the diagnostic accuracy and acceptability of transvaginal sonography ( TVS ) , saline infusion sonography ( SIS ) , and office hysteroscopy ( OHS ) for detecting intracavitary abnormalities in women with or without abnormal uterine bleeding ( AUB ) . DESIGN Prospect i ve double-blind study . SETTING Zekai Tahir Burak Women 's Health Education and Research Hospital , Gynecology Clinic ( Ankara , Turkey ) . PATIENT(S ) A total of 26 women with AUB and 24 women without AUB were enrolled in this study . INTERVENTION(S ) Transvaginal sonography , SIS , and OHS were performed on women scheduled for hysterectomy . MAIN OUTCOME MEASURE(S ) Sensitivity , specificity , and positive and negative predictive values of TVS , SIS , and OHS to detect intracavitary abnormalities ( with histopathologic findings used as the gold st and ard ) , duration of procedure , and pain scores . RESULT ( S ) The sensitivity and specificity of TVS , SIS , and OHS  in detecting intracavitary abnormalities were 56.3 % and 72 % , 81.3 % and 100 % , and 87.5 % and 100 % , respectively . The prevalence of endometrial polyps was not different in women with and without AUB . Saline infusion sonography was less painful than OHS ( pain scores of 4.3 and 7.2 , respectively ) . CONCLUSION ( S ) The diagnostic accuracy of SIS was equal to that of OHS in diagnosing intracavitary abnormalities . Moreover , SIS was less painful than OHS for patients Objective To evaluate the accuracy of transvaginal sonography ( TVS ) and saline infusion sonohysterography ( SIS ) for detection of uterine cavity abnormalities  in patients with abnormal uterine bleeding ( AUB ) taking hysteroscopy as the gold st and ard . Methods This was a prospect i ve study done in the department of Obstetrics and Gynecology of a tertiary care academic hospital . Sixty premenopausal and postmenopausal women who presented with AUB underwent TVS , SIS , and hysteroscopy . The presence of focal abnormality and the type of abnormality , i.e. , polyp , submucous myoma , and endometrial hyperplasia , were noted . The results of TVS and SIS were compared with hysteroscopy . Results On hysteroscopy , 76.67 % ( n = 46 ) patients were diagnosed with intra cavity abnormalities . SIS showed sensitivity , specificity , PPV , and NPV of 89.1 , 100 , 100 , and 73.7 % , respectively . In comparison , TVS showed sensitivity , specificity , PPV , and NPV of 43.48 , 78.57 , 86.96 , and 29.73 % , respectively . Conclusions SIS was found to be more sensitive and specific than TVS in detection of intra cavity abnormalities In this prospect i ve study , 139 patients , 83 premenopausal patients with abnormal uterine bleeding and 56 postmenopausal patients either with metrorrhagia ( 33 ) or a suspect sonographic finding ( 23 ) , were examined preoperatively with transvaginal sonography ( TVS ) and saline contrast hysterosonography ( SCHS ) . The histological results , obtained by hysteroscopy , were compared with the preoperative findings . Uterine pathology ( benign polyps , submucous fibroids , endometrial hyperplasia and carcinoma ) was found in 74.7 % and 76.8 % of the pre- and postmenopausal patients , respectively . TVS and  SCHS  are very sensitive at diagnosing uterine pathology , the latter being more specific and enabling better surgical management and a reduction in unnecessary interventions 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 Background The aim of the study was to compare the accuracy of hydrosonography with that of transvaginal ultrasonography in detection of intracavitary pathologies in patients with history of abnormal uterine bleeding . Study design Prospect i ve , r and omized , and unblinded study . Material and methods A total of 197 women ( n = 130 premenopausal and n = 67 postmenopausal ) aged between 23 and 71 years ( mean age 45.7 ± 8.9 ) presenting with a history of abnormal uterine bleeding were included into the study . Hydrosonography was carried out by experienced gynecologists , on the same setting in an outpatient clinic immediately after the performance of transvaginal sonography . The finally obtained surgical-pathologic findings were compared with the results obtained from transvaginal sonography and hydrosonography .  Sensitivity , specificity , positive , and negative predictive values were calculated for each procedure . Results The surgical-pathologic examination confirmed normal physiologic endometrium in 50 ( 48 % ) of 104 women who were said to have normal endometrium on transvaginal sonography . Seventy ( 75 % ) of 93 women diagnosed of intracavitary pathologies on transvaginal sonography were confirmed by surgical-pathologic findings . The sensitivity , specificity , positive predictive value , and negative predictive value of transvaginal sonography in the detection of intracavitary pathology were 56 , 68 , 75 , and 48 % , respectively . Surgical-pathologic results revealed intracavitary pathologies in 23 ( 30 % ) of 76 women who were said to have normal endometrium on hydrosonography . Among 121 women diagnosed of intracavitary pathologies on hydrosonography , 101 ( 81 % ) women were confirmed after histological evaluation of the surgical specimens . The sensitivity , specificity , positive predictive value , and negative predictive value of hydrosonography in the detection of intracavitary pathology were 81 , 73 , 83 , and 70 % , respectively . Sensitivity and negative predictive value were significantly higher with hydrosonography . There were five cases of endometrial malignancy in which one of the case of malignancy was on polyp and two cases of endometrial hyperplasia with atypia which were not stated on sonographic results . Conclusion Hydrosonography is more accurate than transvaginal ultrasography in the detection of intracavitary pathologies in women with abnormal uterine bleeding This prospect i ve r and omized study was carried out in the department of Radiology and Imaging in collaboration with the department of Obstetrics and Gynecology of Bangab and hu Sheikh Mujib Medical University ( BSMMU ) , Shahbag and Dhaka Medical College Hospital ( DMCH ) during the period of January 2003 to December 2004 . The aim of this study was to establish sonohyterography as a sensitive tool and superior to Transvaginal Sonography ( TVS ) for detection of endometrial pathology in women with abnormal uterine bleeding ( AUB ) and its validity by determining sensitivity , specificity , accuracy , positive predictive value and negative predictive value . For this purpose , a total number of 40 patients who had thickened endometrium ( cut off level < 15 mm for pre menopausal and < 5 mm for post menopausal patients ) detected on transabdominal or transvaginal sonography were selected .  TVS and TV-SH were done in all these patients and findings were then compared with the final histopathological diagnosis . In our study , we found TV-SH has sensitivity of 100 % , specificity of 80 % and accuracy of 97.5 % compared to TVS ( 94 % , 66.66 % and 90 % respectively ) in detection of endometrial pathology in women with AUB . TV-SH can thus be regarded as one of the most sensitive , specific and accurate modality in detecting and excluding endoluminal masses as the cause of AUB . It can be considered as the initial examination in the evaluation of all women with AUB PURPOSE Saline infusion sonography ( SIS ) is a relatively new technique in the evaluation of abnormal uterine bleeding . We compared the diagnostic accuracy of SIS with that of transvaginal sonography ( TVS ) in the detection of intracavitary abnormalities in premenopausal women with abnormal uterine bleeding . METHODS In this prospect i ve study , consecutive premenopausal women who underwent a hysteroscopy for abnormal uterine bleeding also underwent TVS and SIS .  The findings at TVS and SIS were compared with the hysteroscopic and histologic findings . Sensitivity , specificity , and likelihood ratios were calculated . Receiver operating characteristic curves were constructed to assess the performance of endometrial thickness measured using TVS . RESULTS Sixty-two patients were included in the study . TVS demonstrated 60 % sensitivity in directly visualizing intracavitary abnormalities and 93 % specificity . The likelihood ratio of the presence of an intracavitary abnormality was 8 , and the likelihood ratio of the absence of an intracavitary abnormality was 0.43 . Defining an abnormality at TVS as direct visualization of an intracavitary abnormality or an endometrial thickness greater than 5 mm , TVS had an 85 % sensitivity and a 21 % specificity , with corresponding likelihood rati 
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Technical variations such as the use of balloon catheters were not found to affect diagnostic accuracy .
: Transvaginal ultrasonography lacks sensitivity to be used alone to exclude the presence of polyps and leiomyomas in women with abnormal uterine bleeding .
Although less specific than hysteroscopy , saline infusion sonohysterography offers a similar detection rate and permits concomitant visualization of the ovaries and myometrium .