Endometrial thickness screening in premenopausal women with abnormal uterine bleeding

The aim is to compare hysteroscopy, two-dimensional transvaginal ultrasound (2D TVUS), and three-dimensional (3D) Virtual Organ Computer-aided AnaLysis™ (VOCAL) to detect endometrial polyps (EPs) in premenopausal women with abnormal uterine bleeding (AUB). This prospective study was done at Ain Shams Maternity Hospital, Egypt, from March 5, 2015, to December 30, 2015, enrolling 118 premenopausal women with AUB. 2D TVUS, 3D VOCAL, and hysteroscopy were done. 109 patients reached final analysis. 36 women (33%) were diagnosed with EP by 2D TVUS. 50 (45.9%) had EP by hysteroscopy. Endometrial thickness was 10.1 mm by 2D TVUS and endometrial volume was 4.92 mL by VOCAL in women with EP by hysteroscopy compared to 9.9 mm and 3.50 mL in women with no EP, respectively (P=0.223;P=0.06). 2D TVUS has sensitivity, specificity, and positive and negative predictive values of 54%, 84.7%, 75%, and 68.5%, respectively. Endometrial thickness of >7.5 mm has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 82%, 37.3%, 52.6%, 71%, and 57.8%, respectively. Endometrial volume of >1.2 mL has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 90%, 42.4%, 57%, 83.3%, and 64.2%, respectively. 3D VOCAL may be used as a noninvasive method for the diagnosis of EP in premenopausal women with AUB.

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Endometrial study by Ultrasonography and its correlation with Histopathology in Abnormal uterine bleeding

Asian Journal of Medical Sciences ◽

10.3126/ajms.v9i2.19171 ◽

2018 ◽

Vol 9 (2) ◽

pp. 31-35

Author(s):

Pravin Shrestha ◽

Smita Shrestha ◽

Vibha Mahato

Keyword(s):

Endometrial Hyperplasia ◽

Endometrial Thickness ◽

Premenopausal Women ◽

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Common Finding ◽

Proliferative Endometrium ◽

Group 2 ◽

Histopathological Workup

Background: Abnormal Uterine Bleeding is defined as any deviation from a normal menstrual pattern. It is one of the common presentation in extremes of ages. However endometrial hyperplasia and carcinoma are commoner in perimenopausal and postmenopausal women warranting investigations like ultrasonography and endometrial biopsy.Aims and Objective: The aim of the study was to note the endometrial thickness by transabdominal ultrasonography and observe the histopathological pattern in women presenting with abnormal Uterine Bleeding.Material and Methods: Premenopausal women more than 45 years of age and the postmenopausal patients, without any pelvic pathology were included in the study. Endometrial thickness was measured by transabdominal sonography and endometrial biopsy was done. Tissue obtained was sent for histopathological examination.Results: A total of 105 patients were studied. Majority (92%) of patients were premenopausal. Proliferative Endometrium (32%) was the most common finding in premenopausal and atrophic endometrium (37.5%) in postmenopausal group. Malignancy was higher in a postmenopausal group (12.5%) as compared to the premenopausal group (2%). Malignancy was not seen when endometrial thickness was less than 11mm in the premenopausal age group. Endometrial hyperplasia was also more common when the thickness was more than 11mm.In postmenopausal group12.5% of patients, had complex hyperplasia.25% had simple hyperplasia and malignancy was seen in 12.5% of patients. When endometrial thickness was less than 5 mm, hyperplasia and malignancy was not seen.Conclusion: Measurement of Endometrial thickness and histopathological workup in patients above 45 years presenting with abnormal uterine bleeding will be helpful in detecting endometrial hyperplasia and carcinoma.Asian Journal of Medical Sciences Vol.9(2) 2018 31-35

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Response to Mahajan et al.: Endometrial thickness screening in premenopausal women with abnormal uterine bleeding

Journal of Obstetrics and Gynaecology Research ◽

10.1111/j.1447-0756.2007.00697.x ◽

2007 ◽

Vol 33 (6) ◽

pp. 887-887

Author(s):

Chatpavit Getpook

Keyword(s):

Endometrial Thickness ◽

Premenopausal Women ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding

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The Predictive Value of Endometrial Thickness in Endometrial Pathologies in Premenopausal Women with Abnormal Uterine Bleeding

Galen Medical Journal ◽

10.31661/gmj.v2i4.111 ◽

2013 ◽

Vol 2 (4) ◽

pp. 141-145

Author(s):

Roksana Darabi ◽

Mitra Mohit ◽

Hengameh Mohammadkhani ◽

Fathemeh Mohammadyari ◽

Soheila Yadollah-Damavandi

Keyword(s):

Predictive Value ◽

Endometrial Thickness ◽

Premenopausal Women ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Endometrial Polyps ◽

Low Area ◽

Area Under Roc Curve ◽

Sensitivity Specificity

AbstractBackground: Abnormal uterine bleeding (AUB) is one of the most common complains in women of any age seeking gynecologic health care and needs early diagnosis and proper management due to its impacts on the quality of life. This study was conducted to investigate the cut-off value of endometrial thickness (ET) by trans-vaginal ultra-sonography (TVUS) and evaluate its accuracy in the diagnosis of the endometrial abnormalities in premenopausal women with AUB.Materials and Methods: In this descriptive study, 64 married women between 35-50 years old were evaluated due to AUB during 2011-2012; TVUS and fractional curettage were done. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the ET were calculated in different cut-off values.Results: The pathological evaluations of the biopsies were normal in 37 (57.8%) patients and were abnormal in 27 (42.2%) patients, 19 endometrial polyps, 6 hyperplastic lesions and 2 endometrial cancers. ET=4 mm had 100% sensitivity, 100% NPV, 10% specificity and 28% PPV in the detection of endometrial abnormalities. ET<10 mm had a proper sensitivity (67%-100%) and NPV (78.6%-100%) but specificity was low (%10-%44). ET=10 mm with sensitivity=63%, specificity=60%, NPV=65.8% and PPV=48.2% was introduced as the cut-off point with the best area under curve (LR+=2.22 LR- =0.77).Conclusion: Although an ET<10 mm was less likely to be associated with an endometrial abnormality, the low PPV of ET and low area under ROC curve shows sonography has high false positivity in premenopausal women. ET≤4 mm was more reliable and could reduce unnecessary biopsies.

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Endometrial thickness screening in premenopausal women with abnormal uterine bleeding

Journal of Obstetrics and Gynaecology Research ◽

10.1111/j.1447-0756.2007.00674.x ◽

2007 ◽

Vol 33 (6) ◽

pp. 886-886

Author(s):

Niraj N. Mahajan ◽

Kshitija Mahajan ◽

Rajani Soni

Keyword(s):

Endometrial Thickness ◽

Premenopausal Women ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding

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Prediction of Endometrial Hyperplasia and Cancer among Premenopausal Women with Abnormal Uterine Bleeding

BioMed Research International ◽

10.1155/2019/8598152 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Luca Giannella ◽

Lillo Bruno Cerami ◽

Tiziano Setti ◽

Ezio Bergamini ◽

Fausto Boselli

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Prediction Model ◽

Endometrial Hyperplasia ◽

Premenopausal Women ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Stepwise Logistic Regression ◽

Simultaneous Presence ◽

Endometrial Pathology

Objective. To create a prediction model including clinical variables for the prediction of premalignant/malignant endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB). Methods. This is an observational retrospective study including 240 premenopausal women with AUB referred to diagnostic hysteroscopy. Based on the presence of endometrial hyperplasia (EH) or cancer (EC), the women were divided into cases (EH/EC) and controls (no EH/EC). Univariate, stepwise logistic regression and ROC curve analysis were performed. Results. 12 women had EH/EC (5%). Stepwise logistic regression analysis showed that EH/EC associated significantly with BMI ≥ 30 (OR=7.70, 95% CI 1.90 to 31.17), diabetes (OR=9.71, 95% CI 1.63 to 57.81), and a thickened endometrium (OR=1.20, 95% CI 1.08 to 1.34, criterion > 11 mm). The AUC was 0.854 (95% confidence intervals 0.803 to 0.896, p<0.0001). Considering the pretest probability for EH/EC of 5%, the prediction model with a positive likelihood ratio of 8.14 showed a posttest probability of 30%. The simultaneous presence of two or three risk factors was significantly more common in women with EH/EC than controls (50% vs. 6.6 and 25% vs. 0%, respectively, p<0.0001). Conclusion. When premenopausal vaginal bleeding occurs in diabetic obese women with ET > 11 mm, the percentage of premalignant/malignant endometrial pathology increases by 25%. It is likely that the simultaneous presence of several risk factors is necessary to significantly increase the probability of endometrial pathology.

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Correlation Between Endometrial Thickness By Ultrasonography and Histopathology in Abnormal Uterine Bleeding

Annals of Pathology and Laboratory Medicine ◽

10.21276/apalm.2747 ◽

2020 ◽

Vol 7 (3) ◽

pp. A147-151

Author(s):

Sujana G Sujana G ◽

◽

Vivek Gerorge ◽

Aswathy Chandramohan ◽

Sheela Vasudevan ◽

...

Keyword(s):

Endometrial Thickness ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding

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Investigation of Abnormal Uterine Bleeding in Premenopausal Women

Hysteroscopy ◽

10.1016/b978-032304101-0.50016-3 ◽

2009 ◽

pp. 95-114

Author(s):

Linda D. Bradley

Keyword(s):

Premenopausal Women ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding

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Co-relation of endometrial thickness by transvaginal sonogram with histopathology pattern in abnormal uterine bleeding: a study from South India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201198 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1416

Author(s):

Chippy Tess Mathew ◽

Uma Maheswari ◽

Karthikeyan Shanmugam

Keyword(s):

Precancerous Lesions ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Endometrial Sampling ◽

Dilatation And Curettage ◽

Number Of Patients ◽

Fourth Decade ◽

Proliferative Endometrium

Background: Under normal circumstances, a woman's uterus sheds a limited amount of blood during each menstrual period (around 80 ml). Bleeding that occurs erratically or excessive menstrual bleeding is called abnormal uterine bleeding (AUB). The causes of AUB are many and varied. Initial investigations include transvaginal ultrasound and histopathologic assessment of the endometrium. Objective of this study was to evaluation of endometrial thickness with trans-vaginal ultrasound and its correlation with histopathology by dilatation and curettage in abnormal uterine bleeding. To determine the efficacy of transvaginal ultrasound in evaluating the endometrial thickness. To correlate the endometrial thickness by transvaginal ultrasound with endometrial histopathology in women with AUB.Methods: It is a retrospective observational study. All reproductive and perimenopausal age group women who underwent dilatation and curettage for abnormal uterine bleeding during the period June 2014-June 2016 was taken and analyzed and correlated with their endometrial thickness measured with Transvaginal ultrasound.Results: Around 478 patients who underwent endometrial sampling over a period of two years were analyzed. Maximum number of patients were in the fourth decade and the overweight category 36.6%. Proliferative endometrium was the most common histopathologic picture (44.76%). Detection of precancerous lesions were-5.87% and endometrial cancer was 1.05%.Conclusions: An ET of 8 mm and above gave 100% sensitivity and negative predictive value for precancerous and cancerous lesions.

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