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A new study findings by UT Southwestern Medical Center shows that a procedure used in conjunction with a vaginal ultrasound might make it easier to visualize and diagnose diseases in the lining of the uterus. UT Southwestern Medical Center is one of the country's leading academic medical centers, patient-care providers and research institutions . The study was funded by a grant through the American Cancer Society and the patients were all evaluated at Parkland Health and Hospital System in Dallas, the primary teaching hospital for UT Southwestern faculty physicians.

Dr. Elysia Moschos, associate professor of obstetrics and gynecology at UT Southwestern and the lead author of the study says that Saline infusion sonography augments the usual transvaginal sonogram and let the physician see what is inside the endometrium. Abnormal bleeding is a common complaint among patients, particularly during and after menopause. Women experiencing this symptom need to be evaluated for any kind of gynecologic cancers, Dr. Moschos said. The first step should be imaging of
the endometrium by ultrasound.

Physicians evaluated the endometrium, a cavity that lines the inside of the uterus, in women who were in the midst of or had gone through menopause and who complained of abnormal bleeding. Abnormal bleeding can indicate certain diseases of the endometrium that may or may not be malignant.  The current standard of care is to blindly biopsy the endometrium; however, the biopsy might not always sample the part of the cavity that is diseased.

A study available online and in the April issue of Obstetrics and Gynecology shows that using saline-infusion sonography (SIS), or ultrasound, a minimally invasive procedure, allows doctors to actually see where in the endometrium a polyp or growth exists and to biopsy it accordingly.  On a sonogram, water appears dark and tissue is light, so polyps or tumors look bright in comparison with the surrounding saline solution. Using the SIS procedure, physicians inject saline through a catheter threaded into the uterus through the cervix to fill up and expand the endometrial cavity. Doctors can then easily visualize and biopsy an existing growth under sono guidance and send it to a pathologist for analysis.

A total of 88 saline-infusion sonography endometrial samples were obtained. In the final outcome of 80 of those samples, saline-infusion endometrial sampling provided a diagnosis 89 percent of the time, compared with 52 percent for endometrial biopsy.  The study showed there were no women for whom blind biopsy of the endometrium would still be an appropriate first step. The blind biopsies missed 15 of 16 benign polyps and one-third of cancers.  By comparison, two-thirds of benign polyps were correctly diagnosed by saline-infusion sonography endometrial sampling and no premalignant or malignant growths were missed.