Transvaginal hysterosonography in the evaluation of small endoluminal masses

Transvaginal sonography is highly sensitive for detecting endometrial mass lesions, but it is nonspecific. Biopsies performed on patients with abnormal findings seen on TVS often are negative. We performed transvaginal hysterosonography prospectively on 48 consecutive patients with endometrial thickness demonstrated on TVS to be between 5 and 10 mm to assess whether this technique would be useful in the evaluation of such patients. TVHS is a simple, painless technique that is performed by placing a small catheter into the endometrial canal and infusing a small amount of saline solution under sonographic visualization. Of 48 suspected lesions, TVHS confirmed only 19 endoluminal masses: 11 fibroids and eight polyps. Polyps tended to be homogeneously echogenic and to have a pedunculated attachment to the uterine wall without interruption of the endometrial lining. Fibroids showed more heterogeneous echogenicity and had a more sessile attachment. Four patients in our series had false-negative biopsy results prior to having had endometrial mass lesions depicted on TVHS. TVHS may prevent unnecessary biopsies in those patients who appear to have abnormalities on TVS. By depicting the nature of the attachment of endoluminal masses to the uterine wall more clearly, TVHS also may help direct subsequent biopsy procedures.