Fly Thru imaging : feasibility study and comparison with outpatient hysteroscopy

Background: In the investigation of abnormal uterine bleeding, hysteroscopy with endometrial biopsy is considered the gold standard. Fly Thru™ imaging is a new application used to generate virtual hysteroscopy clips. Aims: We aimed to investigate the feasibility and diagnostic accuracy of sonohysterogram with virtual hysteroscopy as an alternative to outpatient diagnostic hysteroscopy. Materials and Methods: Two separate cohorts of women were recruited. The first cohort was to assess feasibility of the application. The second cohort included women recruited to undergo a sonohysterogram, with virtual hysteroscopy, prior to their scheduled outpatient hysteroscopy. Pain scores were recorded after each procedure. Results: Sixteen women were recruited to the feasibility cohort and virtual hysteroscopy post-processing was successfully applied in 14/16 (88%). Clips were produced in less than one minute in 12/16 (75%). Both tubal ostia were identified in 12/16 (75%). Twenty-nine women were enrolled in the correlation cohort with two women excluded as they did not proceed to hysteroscopy according to study protocol. Virtual hysteroscopy, successfully generated in 23/27 women (85%), detected all intra-cavitary pathologies (9/27) detected on outpatient hysteroscopy. Tubal ostia were visualised less often with virtual hysteroscopy (37%) when compared with outpatient hysteroscopy (74%). Sonohysterogram with virtual hysteroscopy was associated with less pain with a median difference in pain score of 2 (interquartile range 1.0–4.0, P < 0.0001). Conclusions: Sonohysterogram with virtual hysteroscopy is feasible; however, the addition of virtual hysteroscopy to sonohysterogram alone has limited value. Larger studies are required to determine whether it can be used as a diagnostic alternative to outpatient hysteroscopy.