A 35-year-old woman with heavy menstrual bleeding is found to have a uterine fibroid on transvaginal ultrasound. The referring physician wants to determine whether the fibroid is submucosal and, if so, classify it preoperatively. The most appropriate investigation for this purpose is:
- A Contrast-enhanced MRI pelvis
- B Hysterosalpingography
- C Saline infusion sonohysterography ✓
- D Diagnostic hysteroscopy
Correct answer: C. Saline infusion sonohysterography
Explanation
Saline infusion sonohysterography (SIS) is the best non-invasive investigation for evaluating submucosal fibroids and determining their FIGO type. It distends the cavity, clearly delineating the intracavitary component and intramural extension. While hysteroscopy is the gold standard for direct visualization, SIS is preferred as the initial preoperative assessment tool and is endorsed by FIGO for fibroid mapping. MRI is excellent for mapping but is costlier and not the first choice for submucosal classification.
Reference: Te Linde's Operative Gynecology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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