Endometrial biopsy in women with abnormal uterine bleeding: inadequate and unassessable categorisation is not clinically relevant

2014 ◽  
Vol 67 (8) ◽  
pp. 673-677 ◽  
Author(s):  
Ayman A A Ewies ◽  
Kadry A A Shaaban ◽  
Reena Merard ◽  
Ulises Zanetto
Keyword(s):  
Endometrial Thickness ◽  
Abnormal Uterine Bleeding ◽  
Final Diagnosis ◽  
Median Number ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Initial Finding ◽  
Significant Difference ◽  
The Difference ◽  
Clinical Records

AimsInadequate endometrial biopsy comprises a dilemma for gynaecologists and histopathologists alike. This study was conducted to assess the clinical merit of classifying scant endometrial biopsy into inadequate and unassessable using McCluggage criteria.MethodsWe retrospectively classified 268 endometrial biopsies, initially reported as inadequate, into inadequate (n=74) and unassessable (n=174) using McCluggage criteria after excluding 20 cases; all taken from patients aged ≥50 years with abnormal uterine bleeding attending Sandwell and West Birmingham Hospitals, UK from 1 January 2007 until 30 September 2012. The electronic clinical records were reviewed to find out the consequent clinical decisions and final outcomes. The follow-up period was 15 months after including the last patient.ResultsThe median age was 57 years (range: 50–97), and the median number of visits to hospital till the diagnosis was achieved was 2 (range: 1–4). The final diagnosis of endometrial hyperplasia or cancer was reported in 9 cases; 5 (7.1%) with an initial finding of inadequate and 4 with unassessable (2.4%); the difference was statistically insignificant (p=0.13). More patients in the inadequate category (82.4%) underwent further investigations when compared with the unassessable category (68.4%); the difference was statistically significant (p=0.029). There was no statistically significant difference in the inadequate to unassessable ratio when the endometrial thickness was ≥5 mm or <5 mm within the Pipelle group (p=0.46) or the curettage group (p=0.34).ConclusionsOur findings suggest that categorising scant endometrial specimens into inadequate or unassessable has no clinical implications. The gynaecologist should interpret the histopathology report in the light of clinical scenario.

scholarly journals A prospective study on the efficacy of Pipelle biopsy to diagnose endometrial pathology in patients with abnormal uterine bleeding

2019 ◽  
Vol 8 (11) ◽  
pp. 4238
Author(s):  
Sunitha Mary Mathew ◽  
Pramod Thomas
Keyword(s):  
Diagnostic Accuracy ◽  
Endometrial Thickness ◽  
Abnormal Uterine Bleeding ◽  
Cost Effective ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Atypical Hyperplasia ◽  
Focal Lesions ◽  
Endometrial Sampling ◽  
Endometrial Pathology

Background: Abnormal uterine bleeding is one of the most common problem encountered in gynaecology clinics. Assessment of endometrial pathology is recommended to rule out malignancy and premalignant conditions. Endometrial sampling can be done by Pipelle biopsy in outpatient units as well as by conventional dilatation and curettage in an operation theatre setup. Our study aims to find out the efficacy of office endometrial biopsy in terms of its sample adequacy, diagnostic accuracy and patient acceptability.Methods: 120 women presenting with abnormal uterine bleeding were included. A detailed history along with clinical examination findings are entered in the proforma. Ultrasound scan was done for all of them to identify pelvic pathology and endometrial thickness. Endometrial sampling was then done with Pipelle without anaesthesia. Histopathology reports are collected and sample adequacy and pattern were analysed. Patients are subsequently followed up for a period up to one year. Those who underwent hysterectomy are analysed for the endometrial pathology in hysterectomy specimen which is used as gold standard and compared with Pipelle endometrial sampling histopathology.Results: Sample adequacy for Pipelle biopsy was found to be 96%. Diagnostic accuracy for atypical hyperplasia and adenocarcinoma is 92.5% and 94% respectively. In hysterectomy specimens, carcinoma endometrium coexisted with atypical hyperplasia in 40% of cases with atypical hyperplasia in pipelle biopsy report.Conclusions: Thus, Pipelle endometrial biopsy is a cost-effective method for endometrial sampling except for focal lesions.

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

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

scholarly journals Evaluation of endometrial thickness with transvaginal ultrasonography in perimenopausal women presenting with abnormal uterine bleeding and correlation with its histopathological findings

2019 ◽  
Vol 8 (11) ◽  
pp. 4496
Author(s):  
Noor Ayesha Begum ◽  
Lokesh Chandra H. C. ◽  
Ravindra S. Pukale
Keyword(s):  
Endometrial Thickness ◽  
Uterine Cavity ◽  
Invasive Procedure ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Transvaginal Ultrasonography ◽  
Common Finding ◽  
Histopathological Findings ◽  
Perimenopausal Women

Background: Abnormal uterine bleeding is the most common presenting menstrual complaint in women of perimenopausal age group. Most frequently used diagnostics tests to investigate the causes of abnormal bleeding are Transvaginal ultrasonography (TVS) and endometrial biopsy. Uterine curettage is an invasive procedure and is performed with anaesthesia. TVS is a non-invasive method that has been used to evaluate the endometrium and uterine cavity. The objectives of this study were to measure and evaluate the role and accuracy of endometrial thickness by transvaginal ultrasonography study to detect endometrial pathology in perimenopausal women presenting with Abnormal Uterine Bleeding. To correlate the transvaginal sonographic results with the Histopathological findings to discriminate normal from pathological endometrium.Methods: Prospective study including 150 perimenopausal women with abnormal uterine bleeding. Endometrial thickness was measured by TVS and then D and C was performed for all the patients.Results: Out of 150 women, 128 (85.3%) had normal and 22 (15%) had an abnormal endometrium. 43.3% were of 41-45 years and 65.3% patients presented with complaint of heavy menstrual bleeding. Majority of the patients in the study group were para 2 or more. Fibroid uterus (24%) was the commonest uterine pathology detected on TVS. 53.3% of patients had endometrial thickness in the range 10-14.9 mm. Most common finding on HPE was secretory endometrium (44.6%). Endometrial carcinoma was found in 3%. Endometrial thickness <14mm was associated with least abnormal endometrial pathology.Conclusions: Endometrial thickness of less than 14 mm need not be indicated for D and C in perimenopausal abnormal uterine bleeding. In perimenopausal women with AUB, TVS should be the investigation of choice due to its convenience, accuracy and non- invasiveness.

scholarly journals Peri- and Postmenopausal Uterine Bleeding Transvaginal Ultrasound with Hysterosonography and Diagnostic Correlation with Hysteroscopy

2011 ◽  
Vol 5 (4) ◽  
pp. 343-352
Author(s):  
Mandakini Parihar ◽  
Anand Parihar
Keyword(s):  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Medical Science ◽  
Abnormal Uterine Bleeding ◽  
Final Diagnosis ◽  
Uterine Bleeding ◽  
Additional Information ◽  
Final Treatment ◽  
Perimenopausal Women ◽  
Cystic Changes

ABSTRACT The recent years have seen medical science and technology expand by leaps and bounds. We have shifted focus from correction of the problem to prevention of the problem. Abnormal uterine bleeding is an important cause of ill health in perimenopausal women. In the perimenopausal years, there is an increase in the incidence of bleeding irregularities. This is because of an increase in the prevalence of benign and malignant uterine lesions. There has also been a significant increase in the number of women presenting with postmenopausal bleeding. At transvaginal ultrasonography (TVS), the finding of a thickened central endometrial complex, with or without cystic changes, is often nonspecific and may be caused by an endometrial polyp, submucosal fibroid, endometrial hyperplasia, carcinoma or cystic atrophy. In addition, because of an increased prevalence of adenomyosis or adenomyosis-like changes in women around this age group, proper transvaginal sonographic assessment of endometrial thickness and abnormalities is of utmost importance but maybe difficult in some women. When TVS cannot accurately measure the endometrial thickness or when there is a nonspecific thickened central endometrial complex, hysterosonography can provide additional information and can help in the diagnosis and final treatment. Hysterosonography, as an adjunct to TVS, allows identification of intracavitary lesions and focal and diffuse endometrial abnormalities and helps determine the abnormality. Final diagnosis confirmed by hysteroscopy. In this review, we discuss these common abnormalities and the correlation of TVS and hysterosonographic findings with hysteroscopic evaluation.

scholarly journals STUDY TO CORRELATE CLINICAL AND HISTOPATHOLOGICAL FINDINGS OF ABNORMAL UTERINE BLEEDING ACCORDING TO FIGO’S PALM-COEIN CLASSIFICATION

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Disha Patel ◽  
Kanaklata D Nakum ◽  
Aditi Vithal
Keyword(s):  
Clinical Diagnosis ◽  
Classification System ◽  
International Comparisons ◽  
Indirect Costs ◽  
Abnormal Uterine Bleeding ◽  
Final Diagnosis ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Histopathological Findings ◽  
Group A

Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs. AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint.  Abnormal uterine bleeding (AUB) is one of the common presenting complaints encountered by a Gynaecologist. The International Federation of Gynaecology and Obstetrics working group on menstrual disorders has recently developed a classification system (PALM–COEIN) for causes of the AUB in non-gravid women. The present study was conducted with the aim to study and analyse the structural (PALM) and the functional (COEIN) component of the PALM–COEIN system of AUB in perimenopausal age group. A total of 200 perimenopausal women (aged 40 years and above till 1 year beyond menopause) who were admitted with complaints of abnormal uterine bleeding comprised the study population. Clinical diagnosis and allocation to PALM–COEIN was done. Endometrial biopsy and hysterectomy specimens (wherever applicable) were obtained and sent for histopathology. As per the histopathological findings, possible underlying causes were categorized. Clinical diagnosis was then correlated with histopathology-based final diagnosis. PALM and COEIN components contributed almost equally for AUB when assessed clinically. The histological examination revealed significantly more cases of PALM (structural or anatomical) component of AUB. The PALM COEIN classification system helps us in understanding various etiological causes of AUB and can be used by clinicians and researchers for international comparisons. Keywords: Abnormal uterine bleeding (AUB) , PALM–COEIN . Perimenopause

scholarly journals Endometrial Evaluation by Histopathology in Abnormal Uterine Bleeding in Perimenopausal and Postmenopausal Patients

2014 ◽  
Vol 1 (2) ◽  
pp. 75 ◽  
Author(s):  
Kairavi Desai ◽  
Kiran Patole ◽  
Manasi Kathaley
Keyword(s):  
Histopathological Examination ◽  
Endometrial Thickness ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Vacuum Aspiration ◽  
Important Symptom ◽  
Proliferative Endometrium ◽  
Laboratory Investigations ◽  
Histopathological Results

<p><strong>Introduction:</strong> Abnormal Uterine Bleeding (AUB) is an important symptom of both benign and serious gynaecological diseases. Abnormal perimenopausal or postmenopausal bleeding is associated with endometrial carcinoma in approximately 10% of cases. The present study is designed to study the histopathological results of the endometrial biopsy in women with abnormal perimenopausal and postmenopausal uterine bleeding.</p><p><strong>Aims and Objectives:</strong> To study, the various histopathological patterns of endometrium, in patients with abnormal uterine bleeding, those are in perimenopausal and postmenopausal age group.<br /><br /> <strong>Materials and Methods:</strong> In all 100 patients were selected for the study after satisfying the specific inclusion and exclusion criteria. They underwent detailed history taking including the pattern of bleeding associated with general, systemic, and pelvic examination. They were subjected to routine laboratory investigations and pelvic ultrasound examination. Endometrial biopsy was done irrespective of endometrial thickness. Endometrial biopsy was done in OPD without anaesthesia. Biopsy was performed using a manual vacuum aspiration syringe, and the material collected was sent for histopathological examination. Endometrium was also obtained from patients undergoing diagnostic or therapeutic dilatation and curettage. Analysis of Histopathology report was done and results were obtained. Results: Most predominant findings of histopathological examination were the … •Proliferative Endometrium in 29% •Simple hyperplasia without atypia 28% •Secretory 20% •Followed by other patterns</p><p><strong>Conclusion:</strong> Study of endometrial histopathology in perimenopausal and postmenopausal women with abnormal uterine bleeding is helpful to diagnose hyperplasia and carcinoma of endometrium.</p>

scholarly journals Clinical Evaluation of Li Brush Endometrial Samplers for Diagnosing Endometrial Lesions in Women With Intrauterine Devices

2020 ◽  
Vol 7 ◽  
Author(s):  
Lu Han ◽  
Sijia Ma ◽  
Lanbo Zhao ◽  
Yu Liu ◽  
Yiran Wang ◽  
...  
Keyword(s):  
Transvaginal Ultrasound ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
High Yield ◽  
Control Group ◽  
Intrauterine Devices ◽  
Significant Difference ◽  
Before And After ◽  
The Impact

Background: For women with intrauterine devices (IUDs), it is difficult to sample the endometrium when abnormal uterine bleeding occurs or when regular screening of endometrial cancer is proposed. The purpose of this study is to evaluate the validity of endometrial sampling using Li Brush in IUD users.Methods: This study was a prospective cohort study and conducted in two parts. Part I was to assess the impact of Li Brush on the position of IUDs. Transvaginal ultrasound was used to locate IUDs before and after sampling. Part II was to explore the diagnostic accuracy of Li Brush in detecting endometrial lesions. IUD users with irregular uterine bleeding were recruited in the IUD group and IUD non-users who arranged for dilatation and curettage (D&amp;C) were recruited in the control group. The endometrium was sampled by Li Brush for cells and by D&amp;C for tissues in both groups. The satisfactoriness of sampling and validity of Li Brush were evaluated.Results: Seventeen cases in part I confirmed no significant difference in the position of IUDs before and after sampling (p = 0.20). 112 IUD users and 139 IUD non-users were recruited in part II. Li Brush achieved 94.64 and 92.09% satisfactory sampling rates in the IUD group and control group, respectively, without statistically significant difference between the two groups (p = 0.42). The Sensitivity and specificity of Li Brush for detection of endometrial lesions in IUD group were 95.35 and 87.76% respectively.Conclusions: Li Brush used for endometrial biopsy did not affect the position of IUDs and had high yield of satisfactory samples and good validity for endometrial diagnoses. It was feasible to screen endometrial lesions by Li Brush for women with IUDs.

scholarly journals Endometrial Cut Off Thickness as Predictor of Endometrial Pathology in Perimenopausal Women with Abnormal Uterine Bleeding: A Cross-Sectional Study

2022 ◽  
Vol 2022 ◽  
pp. 1-6
Author(s):  
Prity Kumari ◽  
Harsha S. Gaikwad ◽  
Banashree Nath
Keyword(s):  
Histopathological Examination ◽  
Endometrial Thickness ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Cross Sectional ◽  
Endometrial Sampling ◽  
Group I ◽  
Significant Difference ◽  
Perimenopausal Women ◽  
Endometrial Pathology

Purpose. We aim to determine the predictive value of endometrial thickness by transvaginal ultrasonography (TVS) in diagnosing endometrial pathology and to evaluate whether Doppler complements its diagnostic efficacy in perimenopausal women with abnormal uterine bleeding. Methods. This cross-sectional observational study was conducted among 70 perimenopausal women with AUB who underwent TVS measurement of endometrial thickness (ET) and Doppler flow indices followed by endometrial sampling and histopathological examination (HPE). Results. In HPE, 51 (73%) women had normal diagnosis while 19 (27%) women had neoplastic histology either benign or malignant. They were categorised into group I and group II, respectively. There was a significant difference in age ( P = 0.001 ) and incidence of obesity ( P = 0.01 ) between the two groups. The ETs measured in group I and group II were 7.89 ± 2.62 mm and 14.07 ± 3.96 mm, respectively, with significant difference ( P < 0.001 ). A TVS-ET of 10.5 mm had the highest sensitivity and specificity of 89.5% and 86.3%, respectively, PPV of 70.68%, NPV of 95.68%, LR+ of 6.52, and LR− of 0.12. Doppler flow velocimetric study of endometrial and uterine vessels did not demonstrate a significant difference. Conclusions. Women in perimenopause with AUB should be offered to undergo endometrial sampling for histopathological examination if TVS ET ≥10.5 mm. The coexisting risk factors especially higher age (>45 years) and obesity (BMI>30) significantly escalate the chances of developing endometrial pathology.

scholarly journals Endometrial Cancer Risk Prediction According to Indication of Diagnostic Hysteroscopy in Post-Menopausal Women

Diagnostics ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 257
Author(s):  
Carlo Saccardi ◽  
Amerigo Vitagliano ◽  
Matteo Marchetti ◽  
Alice Lo Turco ◽  
Sofia Tosatto ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Clinical Relevance ◽  
Endometrial Thickness ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Atypical Hyperplasia ◽  
Secondary Outcome ◽  
Asymptomatic Patients ◽  
Diagnostic Hysteroscopy

We conducted a prospective observational study investigating the clinical relevance of endometrial thickness (ET) and abnormal uterine bleeding (AUB) on endometrial cancer (EC) risk in a cohort of postmenopausal patients undergoing diagnostic hysteroscopy and endometrial biopsy. Patients were divided into two groups according to the indication of diagnostic hysteroscopy: ET_Group (asymptomatic patients with endometrial thickness ≥ 4 mm) and AUB_Group (patients with a history of abnormal uterine bleeding). We further divided the AUB_Group into two subgroups based on endometrial thickness (AUB_Subgroup1: ET < 4 mm; AUB_Subgroup2: ET ≥ 4 mm). The primary outcome was the risk of endometrial cancer and atypical hyperplasia according to the indications of diagnostic hysteroscopy (AUB, ET ≥ 4 mm or both). The secondary outcome was to determine the best cut-off value of endometrial thickness to predict endometrial cancer in asymptomatic postmenopausal women. The prevalence of endometrial cancer and atypical hyperplasia in AUB_Group and ET_Group was 21% and 6.7% respectively. As well as for EC alone, higher prevalence of both conditions was observed in AUB_Subgroup2 (29.3%) in comparison to AUB_Subgroup1 (10.6%; p < 0.001). In asymptomatic patients the cut-off of endometrial thickness that showed the best sensitivity and specificity to diagnose endometrial cancer (100% and 80% respectively) was 11 mm (AUC of 91.4%; Expβ: 1067; CI 95%). In conclusion, considering the high risk of neoplasia, diagnostic hysteroscopy with endometrial biopsy should be mandatory in cases of abnormal uterine bleeding in postmenopausal patients. Moreover, we want to emphasize the need for further evidence stating the clinical relevance of endometrial thickness value in asymptomatic patients and the impact of individual risk factors on endometrial cancer development.

scholarly journals Study of the efficacy of ormeloxifene in abnormal uterine bleeding

2020 ◽  
Vol 9 (12) ◽  
pp. 4941
Author(s):  
Priyanka B. Varwatte ◽  
Michelle Fonseca
Keyword(s):  
Medical Management ◽  
Endometrial Thickness ◽  
Tertiary Care ◽  
Hemoglobin Concentration ◽  
Abnormal Uterine Bleeding ◽  
Significant Rise ◽  
Uterine Bleeding ◽  
Duration Of Treatment ◽  
Significant Difference

Background: Abnormal uterine bleeding (AUB) is a diagnosis that does not apply to menorrhagia only, but also includes (menometrorrhagia) excessively prolonged and frequent bleeding. Ormeloxifene (also known as centchroman) is a selective estrogen receptor modulator. This study was conducted to assess the efficacy, safety and compliance of ormeloxifene in the medical management of AUB.Methods: This quasi experimental, one group pre and posttest research design study was conducted among 30 participants in a tertiary care institute in a metropolitan city during January 2016 to June 2017. Patients with AUB were administered with ormeloxifene were advised to follow up one monthly for the first three months and then three monthly follow up for 6 months.Results: The mean age of all the patients was 35.96±5.62 years. There was statistically significant difference of mean hemoglobin, mean endometrial thickness and mean pregnancy-associated breast cancer (PABC) score observed between pre-treatment and 3 months and 6 months of post treatment. Mean hemoglobin concentration was increased while mean endometrial thickness and mean PABC score was decreased as the duration of treatment was increased from 3 months to 6 months.Conclusions: Ormeloxifene is quick acting, effective and appears to be a promising option for the medical management of dysfunctional uterine bleeding. It leads to a significant reduction in menstrual blood loss, a significant rise in hemoglobin concentration and a significant decrease in endometrial thickness with very minimal side effect.

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