The aim was to assess the value of three-dimensional (3D) ultrasound in improving the diagnosis of intrauterine pathology under performance of saline infusion sonohydro-sonography (SIS) and distinguishing between benign and malignant endometrium in women with postmenopausal bleeding (PMB).
Conventional 2D-SIS is inexpensive, comfortable for the patient method, which does not require any special planning and can be performed at any time when it is regarded to be relevant. SIS has had higher sensitivity (83-88%) than pelvic MRI (76%) and transvaginal sonography (60-69%). The value of combination of 2D ultrasound examination with 3D ultrasound scanning is still not clearly determined. Our study performed in Malmö University Hospital has found that the presence of an irregular focal lesion in the uterine cavity is the best hydrosonography variable for discrimination between benign and malignant endometrium in women with postmenopausal bleeding and endometrial thickness >4.5mm. Our results do not suggest that 3D SIS is superior to 2D SIS either in terms of interobserver agreement or agreement with hysteroscopy findings or for correctly diagnosing endometrial malignancy or other pathology. The findings in the literature available also did not prove that 3D SIS gives any improvement in diagnosing the intrauterine pathology. However, ability to store the digital volumes of expanded uterine cavity and possibility of multiple revisions of these volumes by using any plane slicing method is indisputable convenience for archiving the examinations (not stating a diagnosis when performing an examination) in the clinical practice.