Accuracy of transvaginal sonography in evaluation of abnormal uterine bleeding in perimenopausal women
Keywords:Abnormal uterine bleeding, Endometrial biopsy, Hysteroscopy, Perimenopause, Transvaginal scan
Background: AUB is a commonly encountered complaint in peri- and postmenopausal women visiting OBG OPDs and accounts for about 70% of all gynaecological complaints. Key to management depends on the cause of AUB. Protocol has changed over the years from performing investigations randomly to a condition specific approach. This study aims to evaluate and compare the efficacy of transvaginal sonography and hysteroscopy in perimenopausal women with AUB and note its relation with histopathology.
Methods: A prospective study was conducted on 103 women of 40-55 years presenting to the OBG OPD of Father Muller Medical College Hospital, Mangalore. All patients underwent a transvaginal scan to note the endometrial thickness followed by a hysteroscopy and biopsy. Endometrium was sent for histopathology. Findings of these modalities were correlated.
Results: The diagnostic value of transvaginal sonography in relation to histopathology had a sensitivity and specificity of 33.33% and 95.95% for atrophic endometrium, 52.5% and 62.9% for proliferative, 29.41% and 79.41% for secretory, and 55.55% and 74.19% for hyperplastic. When compared to histopathology, hysteroscopy had a sensitivity and specificity of 100% and 92.3% for atrophic, 26.19% and 96.96% for proliferative, 27.07% and 98.59% for secretory, and 100% and 64.94% for hyperplastic endometrium. It had a sensitivity of 77.77% and a specificity of 92.92% for endometrial polyps. Agreement between TVS and histopathology based on kappa co-efficient was fair for atrophic endometrium but poor for proliferative, secretory and hyperplastic endometrium. Agreement between hysteroscopy and histopathology was moderate for atrophic endometrium and for endometrial polyps. It was fair for proliferative, secretory and hyperplastic endometrium.
Conclusions: TVS seems to be a good initial method for evaluation of AUB. However, a subsequent hysteroscopy with biopsy is advisable to evaluate the cause of AUB.
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