Aim: To evaluate the accuracy of saline infusion sonography for the diagnosis of endometrial cavity abnormalities in patients who presented with abnormal uterine bleeding. Methods: Eighty-three women suspected of having endometrial cavity abnormalities were evaluated using saline infusion sonography. The results of this technique were compared with the histological evaluation reports of these women either with hysteroscopy or laparotomy prospectively. Results: The positive predictive value (PPV) for endometrial polyps was 25%; the negative predictive value (NPV) was 93%; the sensitivity for endometrial polyps was 80% and the specificity was 87%. The PPV, the NPV, the sensitivity and the specificity for submucous fibroids were 65, 85, 81 and 89%, respectively. Conclusions: Saline infusion sonography was a reliable and accurate method for investigations of the endometrium and uterine cavity with good correlation, with histological results of more invasive procedures. It can be a good alternative technique for the evaluation of uterine cavity abnormalities where office hysteroscopy is not available. © 2008 Springer-Verlag.