Background: Abnormal uterine bleeding is a common reason for gynecological visits and a significant cause for anemia in perimenopausal women which should be investigated properly.
Objective: To compare the diagnostic accuracy of 3D U/S and hysteroscopy in detecting uterine lesions in cases of perimenopausal bleeding.
Patients and methods: The study included 100 patients from the outpatient Gynecological Clinic, Al Hussein, Al Sayed Galal Hospitals Al-Azhar University during the period starting from October 2019 till May 2021. All patients were suffering from pre-menopausal bleeding and were between 41 and 50 years old.
Results: Hysteroscopy detected adenomyosis in 0cases (0%), fibroid in 32 cases (32%), hyperplasia in 19 cases (19%), polyps in 17 cases(17%) and no pathology in 32 cases (32%). In cases of fibroids: 3D U/S has a sensitivity 96 %, specificity 45.45 % and accuracy 80.56% as for hysteroscopy, it has a sensitivity 95.24%, specificity 78.57% and accuracy 88.57 %. In cases of polyps: 3D U/S has a sensitivity 80%, specificity 80 % and accuracy 95 % as for hysteroscopy, it has a sensitivity 100%, specificity 100% and accuracy 100%. In cases of all lesions: 3D U/S has a sensitivity 67.74 %, specificity 54.55 % and accuracy 65.75 % as for hysteroscopy; it has a sensitivity 84.48%, specificity 78.57% and accuracy 83.33%
Conclusion: 3D ultrasound is a sensitive method to evaluate the endometrial cavity lesions but hysteroscopy allows direct visualization of the uterine cavity so it can detect small localized intrauterine lesions which could be missed by 3D ultrasound .