DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20200368

Evaluation of endometrium by transvaginal ultrasonography and hysteroscopy and its correlation with histopathology in perimenopausal women with abnormal uterine bleeding at tertiary rural centre

Priyanka Singh, Kalpana Kumari, Shikha Seth, Vandana Verma, Vikram Singh

Abstract


Background: Abnormal uterine bleeding is one of the commonest clinical presentation ac-counts for 33% gynaecological consultations and this proportion rises to 70% in perimenopausal and postmenopausal age group in any gynaecology clinic. The most probable etiology of abnormal uterine bleeding relates to the patients reproductive age. Various diagnostic techniques have been evolved over the periods to determine the etiology of abnormal uterine bleeding in perimenopausal women, but their accuracy has not been compared properly. The aim of study is to evaluate the endometrium by transvaginal ultrasonography and hysteroscopy and its correlation with histopathology in perimenopausal patients with abnormal uterine bleeding.

Methods: Total 96 patients in perimenopausal age group, admitted with chief complaints of ab-normal uterine bleeding were included. All patients underwent transvaginal ultrasonography and hysteroscopy, followed by hysteroscopy guided biopsy and histopathological examination. Accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated for both methods and compared, considering histopathological diagnosis as gold standard.

Results: Mean age of patients was 44.05±3.29. Hysteroscopy has high accuracy, sensitivity, specificity, positive predictive value and negative predictive value than Transvaginal sonography for diagnosis of all endometrial and intrauterine pathologies.

Conclusions: Hysteroscopy results are more consistent with the results of histopathology. Hysteroscopy and hysteroscopy guided biopsy has been proven as gold standard for endometrial evaluation of patients with abnormal uterine bleeding. TVS can be used as most cost effective first step investigation in cases of perimenopausal bleeding.


Keywords


Abnormal uterine bleeding, Histopathology, Hysteroscopy, Transvaginal ultrasonography, perimenopausal women

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References


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

Mahajan N, Aggarwal M, Bagga A. Health issues of menopausal women in North India. J Midlife Health. 2012;3:84-7.

Soules MR, Sherman S, Parrott E, Rebar R, Santoro N, Utian W, et al. Executive summary: stages of reproductive aging workshop (STRAW). Fertil Steril. 2001;76(5):874-8.

Goldstein SR, Zeltser I, Horan CK, Snyder JR, Schwartz LB. Ultrasonography based triage for perimenopausal patients with abnormal uterine bleeding. Am J Obstet Gynecol. 1997;177:102-8.

Munro MG, Critchley Ho, Broder MS, Eraser IS. FIGO classification system (PALM-CO-EIN) for causes of abnormal uterine bleeding in non-gravid women of reproduction age. FIGO Working Group on Menstrual Disorders. Int J Gynecol Obstet. 2011;113:3-13.

Aslam M, Ijaz L, Tariq S Shafqat K. Comparison of transvaginal sonography and saline contrast sonohysterograhy in women with abnormal uterine bleeding: correlation with hysteroscopy and histopathology. Int J Health Sci. 2007;1(1):17-24.

Cooper JM, Brady RM. Hysteroscopy in the management of abnormal uterine bleeding. Ob-stet Gynecol Clin North Am. 1999;26(1):217-36.

Nagele FO, O'connor H, Davies A, Badawy A, Mohamed H, Magos A. 2500 outpatient diagnostic hysteroscopies. Obstet Gynecol. 1996;88(1):87-92.

Lotha L, Borah A. Clinicopathological evaluation of abnormal uterine bleeding in peri-menopausal women. Int J Reprod Contracept Obstet Gynecol. 2016;5(9):3072-74.

Talukdar B, Mahela S. Abnormal uterine bleeding in perimenopausal women: Correlation with sonographic findings and histopathological examination of hysterectomy specimens. J Midlife Health. 2016;7(2):73-77.

Katke RD, Zarariya AN. Use of diagnostic hysteroscopy in abnormal uterine bleeding in perimenopausal age group and its clinicopathological correlation with ultrasound and histopathology findings: experience in a tertiary care institute. Int J Reprod Contracept Obstet Gynecol. 2015;4(2):413-8.

Pillai SS. Sonographic and histopathological correlation and evaluation of endometrium in perimenopausal women with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2014;3(1):113-17.

Malpani A, Singer J, Wolverson MK, Merenda G. Endometrial hyperplasia: value of endometrial thickness in ultrasonographic diagnosis and clinical significance. J Clin Ultrasound. 1990;18:173-7.

Singh S, Taneja BK, Singh P et al. Role of diagnostic hysteroscopy in abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2014;3:544-51.

Patil SG, Bhute SB, Inamdar SA, Acharya NS, Shrivastav DS. Role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathological correlation. J Gynecol Endosc Surg. 2009;1(2):98-104.

Jaiswar SP, Sachan R, Srivastava PK, Goel M, Pande M. A comparative diagnostic evalua-tion of hysteroscopy, transvaginal ultrasonography and histopathological examination in cases of abnormal uterine bleeding. J Obstet Gynecol India. 2006;56(3):240-3.

Subhankar D, Chakraborty B, Rejaul K, Kanti AR, Kumar MP, Kumar GT. Abnormal uter-ine bleeding in perimenopausal age: diagnostic options and accuracy. J Obstet Gynecol India. 2011;2(1):189-94.

Bouzari Z, Yazdani S, Esmailzadeh S, Shahhoseini R, Fazli A, Naeimi M. Hysteroscopy vs transvaginal ultrasonography in the diagnosis of endometrial lesions. Caspian J Reprod Med. 2016;2(1):21-6.