Abnormal uterine bleeding: a critical analysis of two diagnostic methods

Manisha Jain, Anjali Kanhere, Ajay Kumar Kumar Jain

Abstract


Background: Abnormal Uterine Bleeding (AUB) is one of the most common reasons for women to seek gynaecology   consultation. The underlying causes in AUB are many and identifying the exact cause can be a real challenge to the treating gynaecologists. Objectives of current study are to study the common etiology of AUB and to study and correlate the diagnoses of Trans Vaginal Sonography (TVS) and Diagnostic Hysteroscopy (DH) with histopathology diagnosis.

Methods: One hundred and thirteen women with AUB were enrolled and evaluated by conventional TVS and DH. The findings were correlated with histopathology diagnosis. The sensitivity, specificity and positive and negative predictive value of TVS and DH were calculated after comparison with final histopathology diagnosis.

Results: Fibroids and polyps were the two commonest structural lesions in AUB. For submucosal fibroids, the sensitivity and specificity of DH was found to be 92% and 99% respectively while that of TVS was found to be 85 % and 100 % respectively. For polyps, the sensitivity and specificity of DH was found to be 91% and 98 % respectively and that of TVS was 68% and 93 % respectively. The coefficient of correlation for DH was better than that of TVS.

Conclusions: Fibroids and polyps are the two commonest structural lesions causing AUB in the women of reproductive age group.  TVS has a role as primary screening method for the initial work-up AUB before resorting to invasive procedure such as hysteroscopy.


Keywords


Abnormal uterine bleeding, Diagnostic hysteroscopy, Transvaginal sonography

Full Text:

PDF

References


Christopher D. Williams, Paul B. Marshburn. A propective study of transvaginal hydrosonography in the evaluation of abnormal uterine bleeding. Am J Obstet Gynecol. 1998;179:292-8.

Theresa Widrich, Linda Bradley, Allison R, Mitchinson. Comparison of saline infusion sonography with office hysteroscopy for the evaluation of the endometrium. Am J Obstet Gynecol. 1996;174:1327-34.

Nancy C Lee, Richard C Dicker, George L Rubin, Howard W Ory. Confirmation of the preoperative diagnoses for hysterectomy. Am J Obstet Gynecol. 1984;150:283-7.

Jaiswar SP, Sochan R, Shrivastava 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;56:240-3.

Franklin D Lofter. Hysteroscopy with selective endometrial sampling compared with D&C for abnormal uterine bleeding: the value of negative hysteroscopic view. Obstet Gynecol. 1989;73:16-20.

Lawrence P. O’Connell, Melissa H. Fries, Ernest Zeringue, Walter Brehm. Triage of abnormal postmenopausal bleeding: A comparison of endometrial biopsy and transvaginal sonohysterography versus fractional curettage with hysteroscopy. Am J Obstet Gynecol. 1998;178(5):956-61.

Cynthia Farquhar, Alec Ekeroma, Susan Furness, Bruce Arroll. A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Acta Obstet Gynecol Scand. 2003;82:493-504.

Sima Mukopadhyay, Bhattacharya SK, Ganguly RP, Patra KK, Bhattacharya N, Barman SC. Comparative evaluation of perimenopausal abnormal uterine bleeding by transvaginal sonography, hysteroscopy and endometrial biopsy. J Indian Med Assoc. 2007;105:624-30.

Sheetal G Patil, S B Bhute, S A Inamdar, Neema S Acharya and Deepti S Shrivastava. Role of Diagnostic Hysteroscopy in Abnormal Uterine Bleeding and its Histopathologic Corelation. J Gynecol Endosc Surg. 2009 Jul – Dec;1(2):98-104.

E. Dreisler, S. Stampe Sorensen, P. H. Ibsen and G. Lose. Value of endometrial thickness measurement for diagnosing focal intrauterine pathology in women without abnormal uterine bleeding. Ultrasound Obstet Gynecol. 2009;33:344-8.