DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20183326

Correlation between ultrasonographic, hysteroscopic and histopathological findings in patients with abnormal uterine bleeding

Binti R. Bhatiyani, Shrikant Dhumale, Pandeeswari ., Dolly Bashani

Abstract


Background: Menstrual disorders are common indication for medical visits among women of reproductive age and heavy menstrual bleeding affects up to 30% of women throughout their reproductive lifetime. This study aims at evaluating the different causes and, the clinical presentation of AUB and to compare the role of hysteroscopy, ultrasonography and histopathology in patients with AUB.

Methods: 100 women above 45 years of age, presenting with abnormal bleeding per vaginum were evaluated. All patients underwent transvaginal scan to note down the endometrial thickness and to rule out uterine and adnexal pathology. All the patients underwent diagnostic hysteroscopy, followed by a biopsy of the endometrium using a curette. The endometrium was sent to the pathologist. Findings of these diagnostic modalities then correlated.

Results: Incidence of AUB was present between the age groups of 45-49 years of age (66%). The commonest presenting complaint in this series was menorrhagia or heavy menstrual bleeding (60%). The finding of thickened endometrium as the most common abnormality on USG (44%) and also on hysteroscopy (45%). As per present study the sensitivity of hysteroscopy is 97.78% and specificity was 34.55%, the negative predictive value of the test is 95%.

Conclusions: TVS may be the first line of investigation while evaluating the endometrium in a perimenopausal AUB. It helps to triage the patients into high risk or low risk. Endometrial thickness >4mm as per the present study needs further evaluation. Patients with endometrial thickness less than 4 mm can be reassured. Hysteroscopy is the gold standard in the diagnosis of focal pathology like sub mucous fibroid, polyps or anomalies. Histopathology probably is an indispensable tool specially to rule out premalignant and malignant conditions. Thus, all the modalities instead of being competitive to one another, are complimentary to each other. For complete evaluation of patient with AUB all the three modalities should be used together to come at exact diagnosis.


Keywords


Abnormal uterine bleeding, Hysteroscopy, Histopathology, Ultrasonography

Full Text:

PDF

References


Munro MG, Critchley HO, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding. Int J Gynecol Obstet. 2011;113(1):1-2.

Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. In Seminars in Reprod Med. 2011;29:(5):383-90.

Market Opinion and Research International (MORI). Women’s health in 1990. (Research study conducted on behalf of Parke-Davis Laboratories). London: MORI; 1990.

Paula J, Berek AH, Novak’s Gynaecology: benign diseases of female reproductive tract, 15th ed. Philadelphia: Wolter Kluwer India Pvt Ltd; 2012:404.

Stock RJ, Kanbour A. Prehysterectomy curettage. Obstet. 1975;45(5):537-41.

William J. Butler, David E. Carnovale. Normal and abnormal uterine bleeding. In: Chapter 26, Telinde’s operative gynaecology 10th ed. John A Rock, Howard W. JonesIII (eds). New Delhi: Wolters Kluwer health and Lippincott Williams and Wilkins 2009:585-605.

Krampl E, Bourne T, Hurlen-Solbakken H, Istre O. Transvaginal ultrasonography sonohysterography and operative hysteroscopy for the evaluation of abnormal uterine bleeding. Acta Obstet Gynecol Scand. 2001;80(7):616-22.

Pasqualotto EB, Margossian H, Price LL, Bradley LD. Accuracy of preoperative diagnostic tools and outcome of hysteroscopic management of menstrual dysfunction. J Am Assoc Gynecol Laparoscopists. 2000;7(2):201-9.

Erdem M, Bilgin U, Bozkurt N, Erdem A. Comparison of transvaginal ultrasonography and saline infusion sonohysterography in evaluating the endometrial cavity in pre-and postmenopausal women with abnormal uterine bleeding. Menopause. 2007;14(5):846-52.

Patil SG, Bhute SB, Inamdar SA, Acharya NS, Shrivastava DS. Role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathologic correlation. J Gynecol Endoscop Surg. 2009;1(2):98.

Kathuria R, Bhatnagar BE. Correlation between D and C, USG and hysteroscopy findings in diagnosing a cause for abnormal uterine bleeding. Indian J Clin Practice. 2014;25(5):466-70.

Pyari JS, Rekha S, Srivastava PK, Goel M, Pandey M. A comparative diagnostic evaluation of hysteroscopy, transvaginal ultrasonography and histopathological examination in cases of abnormal uterine bleeding. J Obstet Gynecol India. 2006;56(3):240-3.

Sharma J, Tiwari S. Hysteroscopy in Abnormal Uterine Bleeding vs Ultrasonography and Histopathology Report in Perimenopausal and Postmenopausal Women. J Nepal Med Assoc. 2016 1;55(203).

Srinivas K, Kulkarni S Comparison of Efficacy of TVS and Hysteroscopy with Histopathology of the Endometrium in Evaluating Perimenopausal AUB (O). MOJ Women’s Health. 2017;4(6):00104.

Karlsson B, Granberg S, Hellberg P, Wikland M. Comparative study of transvaginal sonography and hysteroscopy for the detection of pathologic endometrial lesions in women with postmenopausal bleeding. J Ultrasound Med. 1994;13(10):757-62.

El-khayatW, Sleet ME, Mahdi EY. Comparative study of transvaginal sonography and hysteroscopy for the detection of pathological endometrial lesions in women with perimenopausal bleeding. Middle East Fertil Soc J. 2011;16(1):77-82.