Obstetrics and Gynecology · MU Sofia

42. Special diagnostic methods in gynecology - ultrasound, cytology, colposcopy, HSG (hysterosalpingography), D&C (dilation and curettage), laparoscopy, hysteroscopy

Covers the main special investigations in gynecology, moving from imaging (transvaginal ultrasound, saline infusion sonography, HSG, MRI and CT) to cytology and tissue sampling (cervical screening, colposcopy, endometrial biopsy, D&C, culdocentesis, tumour markers) and then to endoscopy. A comparison table sets laparoscopy against hysteroscopy on method, diagnostic and operative uses, and complications. It ends with a note on the endometrial assessment needed for postmenopausal bleeding.

Inside: 4 sections · 1 table · 16 flashcards · 2 min

Topic 42 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 4 sections, about 255 words (2 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Imaging
  3. Cytology and tissue sampling
  4. Endoscopy

Introduction

Special investigations complement the clinical examination: they image the pelvis, sample tissue and look directly into the cavities.

Imaging

  • Transvaginal ultrasound: first-line for the uterus and ovaries; endometrial thickness (postmenopausal > 4 mm needs sampling), fibroids, cysts (simple versus complex, IOTA rules), ectopic pregnancy, follicle tracking. Transabdominal for large masses or girls.
  • Saline infusion sonography: polyps and submucous fibroids.
  • Hysterosalpingography (HSG): contrast through the cervix under X-ray; shows the cavity and tubal patency (spill into the peritoneum). Done in the follicular phase (after menses, before ovulation); risk of infection (antibiotic cover). HyCoSy is the ultrasound alternative.
  • MRI (fibroids, adenomyosis, cancer staging), CT (cancer staging), PET.

Cytology and tissue sampling

  • Cervical cytology (Pap smear or liquid-based) and HPV testing: screening for cervical precancer.
  • Colposcopy: magnified view of the cervix after acetic acid (abnormal epithelium turns white) and Lugol's iodine (normal glycogen-rich epithelium stains brown, abnormal stays pale, Schiller test); directed biopsy of the transformation zone.
  • Endometrial biopsy (Pipelle) in outpatients.
  • Dilatation and curettage (D&C), or fractional (separate) curettage: endocervical canal and uterine cavity sampled separately, for abnormal bleeding and to localise endometrial cancer. Now largely replaced by hysteroscopy with biopsy.
  • Probe of the uterine cavity (uterine sound): length and direction of the cavity.
  • Culdocentesis (puncture of the pouch of Douglas through the posterior fornix): blood in ectopic pregnancy, pus in abscess; now replaced by ultrasound.
  • Tumour markers: CA-125 (ovarian epithelial), hCG, AFP, LDH (germ cell), inhibin (granulosa cell), CEA.

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