Correlation of histopathological findings with ultrasound imaging and hysteroscopic findings in perimenopausal and postmenopausal women with abnormal uterine bleeding
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20243444Keywords:
Abnormal uterine bleeding, Histopathology, Polyp, Endometrium, HysteroscopyAbstract
Background: Heavy breakthrough bleeding is a very frequent complaint in gynecological practice, more common during perimenopause and can be associated with structural pathologies, and abnormalities. Proper diagnosis as well as treatment are very vital for enhancing quality of the lives of such individuals and also treating possible malignancies. This research paper discusses the correlation of clinical presentation, USG and histopathology in the diagnosis of AUB in women to determine the most effective course of action. To compare and describe clinical features of AUB in perimenopausal and postmenopausal women and to posit Association between ultrasound findings and histopathological examination of hysterectomy samples, as well as to identify types of causal pathology.
Methods: A cross-sectional study was carried out in the Obstetrics and Gynecology department of a tertiary teaching hospital. Finally, 200 women aged 45 and above with AUB were recruited over a three-year period. Information on clinical presentation was also obtained and ultrasonographic evaluation with regard to endometrial thickness and uterine abnormalities noted. Objective assessment of the findings obtained by USG was done by histopathological examination of hysterectomy specimens and statistical correlation was done.
Results: 200 patients diagnosed with AUB aged 45 years and above, 66% of the patients were aged between 45-49 years. The highest frequency of pain was reported during menstruation followed by postmenstrual and intermenstrual pain; heavy menstrual bleeding was most prevalent 60%, postmenopausal bleeding 12% and intermenstrual bleeding 11%. The detailed ultrasonographic changes were abnormal in 83% of patients; endometrial thickening was seen in 44%, and fibroids in 17%. Comparison between hysteroscopy, and histopathological findings showed abnormal endometrium had significant positive relation with each other p=0.02.
Conclusion: This study shows that USG offers value as the primary diagnostic modality, especially in diagnosing fibroid-associated AUB.
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References
Davis E, Sparzak PB. Abnormal Uterine Bleeding. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing. 2023. Available at: https://www.ncbi.nlm.nih.gov/books. Accessed on 16 July 2024.
Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13.
Mishra D, Sultan S. FIGO's PALM-COEIN Classification of Abnormal Uterine Bleeding: A Clinico-histopathological Correlation in Indian Setting. J Obstet Gynaecol India. 2017;67(2):119-25.
Kamińska MS, Schneider-Matyka D, Rachubińska K, Panczyk M, Grochans E, Cybulska AM. Menopause Predisposes Women to Increased Risk of Cardiovascular Disease. J Clin Med. 2023;12(22):7058.
Meeta M, Digumarti L, Agarwal N, Vaze N, Shah R, Malik S. Clinical practice guidelines on menopause. an executive summary and recommendations: indian menopause society 2019-2020. J Midlife Health. 2020;11(2):55-95.
Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65.
Sung S, Carlson K, Abramovitz A. Postmenopausal Bleeding. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK562188/.
Yazdaan HE, Jaya F, Sanjna F, Junaid M, Rasool S, Baig A, Natt MZ, Maurya N, Iqbal S, Yeldo BA, Khan AS, Varrassi G, Kumar S, Khatri M, Awan SK. Advances in Thyroid Function Tests: Precision Diagnostics and Clinical Implications. Cureus. 2023;15(11):48961.
Kondagari L, Kahn J, Singh M. Sonography gynecology infertility assessment, protocols, and Interpretation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2023. Available at: https://www.ncbi.nlm.nih.gov/books. Accessed on 22 July 2024.
Mahdy H, Casey MJ, Vadakekut ES, et al. Endometrial Cancer. [Updated 2024 Apr 20]. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2024. Available at: https://www.ncbi.nlm.nih.gov. Accessed on 18 July 2024.
Louis F, Lulla CP. Hysteroscopy is superior to 3d ultrasound in gynecological diagnosis. J Obstet Gynaecol India. 2020;70(6):447-61.
Singh G, Cue L, Puckett Y. Endometrial Hyperplasia. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK560693/. Accessed on 2 August 2024.
Zia MS, Hanif S, Shaheen M. Correlation of Sonographic Findings and Histopathological Examination of Hysterectomy Specimens in Perimenopausal Patients with Abnormal Uterine Bleeding. Journal of The Society of Obstetricians and Gynaecologists of Pakistan. 2021;11(3):176-80.
Mahapatra S, Chavan NN, Mirza H, Rajput H. Correlation of ultrasound, hysteroscopic and endometrial histopathology findings in patients with post-menopausal bleeding. Int J Reprod Contracep Obst and Gynecol. 2022;11(5):1540.
Modak R, Pal A, Pal A, Bose K. Abnormal uterine bleeding in perimenopausal women: sonographic and histopathological correlation and evaluation of uterine endometrium. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2020;9(5):1959-65.
Upadhyay A, Tyagi M, Gupta S, Bansal R, Varma Y. Comparative study of hysteroscopy with ultrasonography and its correlation with histopathology in cases of abnormal uterine bleeding in perimenopausal women. Int J Reprod Contrac Obst Gynecol. 2022;11(3):791-8.
Thomas J. Clinico-histopathological and ultrasonographic correlation of abnormal uterine bleeding in perimenopausal and postmenopausal women. Int J Reprod Contra Obst Gynecol. 2021 Jun 1;10(6):2408-14.
Vempalli M, John LB, Chandana G. Correlation of clinical and ultrasonographic features with histopathology in post-menopausal bleeding. Int J Reprod Contr Obs Gynecol. 2020;9(7):2817-23.
