Transvaginal ultrasonography versus hysteroscopy in endometrial pathology diagnosis among women with abnormal uterine bleeding

Objective: Abnormal uterine bleeding is any deviation from a normal menstrual pattern. Transvaginal ultrasonography is useful in determining endometrial thickness but cannot conclusively exclude sessile and pedunculated lesions. Hysteroscopy is an invasive procedure that detects discrete lesions. This study was aimed to evaluate the diagnostic accuracy of 2-dimensional transvaginal ultrasonography and hysteroscopy in evaluating endometrial lesions in women with abnormal uterine bleeding, by determining the sensitivity and specificity of the two methods in diagnosing the lesions. Methods: Eighty-four cases of abnormal uterine bleeding were chosen based on inclusion criteria. The patients were subjected to routine investigations. The findings of transvaginal ultrasonography, hysteroscopy, and dilatation and curettage were compared and analyzed. Results: Maximum incidence of abnormal uterine bleeding was observed in women between 41 and 50 years of age (73.8%). The most common presenting complaint was menorrhagia (76.1%). 76% of patients experienced symptoms for less than six months. The sensitivity and specificity of transvaginal ultrasonography were 60% and 96.3%, respectively. The sensitivity and specificity of hysteroscopy were 80.4% and 93.1%, respectively. The accuracy of transvaginal ultrasonography was 60.3%, and that of hysteroscopy was 83.3%. Conclusion: Transvaginal ultrasonography and hysteroscopy can be used as first-line diagnostic modalities to rule out and find the causes of abnormal uterine bleeding, which can aid in instituting prompt and appropriate medical treatment.

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194882 ◽

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.

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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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Hysterosonography and Transvaginal Ultrasonography for Detection of Intrauterine Lesions in Women with Abnormal Uterine Bleeding

Annals of King Edward Medical University ◽

10.21649/akemu.v23i1.1510 ◽

2017 ◽

Vol 23 (1) ◽

Author(s):

Iqbal Hussain Dogar ◽

Mahjabeen Masood ◽

Mahesh Gautam ◽

Mahjabeen Tariq

Keyword(s):

Sensitivity And Specificity ◽

Imaging Modality ◽

Transvaginal Ultrasound ◽

Abnormal Uterine Bleeding ◽

Vital Role ◽

Uterine Bleeding ◽

Endometrial Polyp ◽

Transvaginal Ultrasonography ◽

Detection And Identification ◽

Line Imaging

Abnormal Uterine bleeding (AUB) is one of the frequent complaints of female patients of all ages. AUB is present in 33% of women referred to gynecologists and this increases to 69% in perimenopausal and postmenopausal women. About 10 % of postmenopausal bleeding results from endometrial cancer and imaging is the mainstay for its identification. Imaging plays a vital role in differentiating structural lesions like endometrial carcinomas, myomas and polyps which require surgical management from functional disorders requiring medical management. Transvaginal Ultrasonography (TVUS) is the first line imaging modality for AUB after selecting the patients with inconclusive pelvic ultrasonographic results. Hysterosonography (HSG) also plays a pivotal role.Objectives: To compares between TVUS and HSG in the detection and identification of intrauterine lesions in patients with abnormal uterine bleeding, and comparing the sensitivity and specificity of the respective methods in the detection of such lesions.Methods: Thisstudy was conducted in Department of Radiology, Mayo Hospital Lahore. Fifty women presented with history of abnormal uterine bleeding were included in this study. Pregnancy was ruled out by transabdominal scan. Transvaginal ultrasound and hysterosonography were performed in all the patients. All the data were coded and analyzed using SPSS version 20.Results: Out of 50 patients, 10 patients had intramyometrial fibroid, 11 had submucosal fibroid, endometrial polyp was found in 17 patients and 2 patients had thickened endometrium (thickness > 8mm). The sensitivity and specificity of TVUS was found to be 83.2% and 82.7% respectively whereas HSG showed sensitivity and specificity of 95.4% and 91.5% respectively. In the detection of the submucosal fibroid and endometrial polyp, HSG showed highest sensitivity and specificity as compared totransvaginal ultrasound.Conclusion: Both the TVUS and HSG have comparable sensitivity and specificity in the detection of endometrial disease in patients presented with abnormal uterine bleeding however HSG is more sensitive in the detection of polyps.

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Frequency of Common Histopathological Findings among Patients Having Endometrial Thickness ≥5mm

10.53350/pjmhs211592236 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2236-2238

Author(s):

Sadia Sharif ◽

Ayesha Sajjad ◽

Amna Kazi ◽

Ayesha Masood ◽

Nazish Javaid

Keyword(s):

Body Mass Index ◽

Endometrial Carcinoma ◽

Body Mass ◽

Rural Areas ◽

Endometrial Thickness ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Transvaginal Ultrasonography ◽

Cross Sectional ◽

Histopathological Findings

Aim: To determine the frequency of common histopathological findings among patients having endometrial thickness >5mm and having atypical bleeding of uterus. Study design: Descriptive and cross sectional study Study settings: Department of Obstetrics & Gynaecology, Kishwer Fazal Teaching Hospital, Sheikhupura from 1st October 2020 to 31st March 2021. Methodology: One hundred and twenty patients were enrolled. Patients were aged between 45 to 60 years. Patient’s detailed demographics including age, parity, socioeconomic grade and body mass index were recorded post written informed consentreceival. Patients having endometrial thickness >5mm with abnormal uterine bleeding were included in this study.All the patients were undergone for transvaginal ultrasonography (TVS). Outcomes were histopathological findings observed. Results: The patients mean age was found to be 51.16±4.88 years with mean body mass index 27.24±4.63 kg/m2. Thirty five (29.2%) patients had parity I and 85 (70.8%) patients had parity II. Forty two (35%) patients had high socioeconomic status and 78(65%) were from low socio economic status. Majority of the patients 80(66.7%) were from rural areas. Secretory and proliferative were the most common histopathological findings found in (45.83% and 26.7%) patients. Frequency of endometrial carcinoma was found among 97(80.8%) cases. Conclusion: The most common histopathological findings were secretory and proliferative and frequency of endometrial carcinoma was too high. Endometrial anomalies can be excluded by transvaginal ultrasonography and is strongly useful in the evaluation of abnormal bleeding from the uterine. Keywords: Endometrial, Transvaginal ultrasonography, Uterine bleeding

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Transvaginal Ultrasonography and Saline Infusion Sonohysterography for the Detection of Intra-Uterine Lesions in Pre- and Post-Menopausal Women with Abnormal Uterine Bleeding

Journal of International Medical Research ◽

10.1177/147323000803600606 ◽

2008 ◽

Vol 36 (6) ◽

pp. 1205-1213 ◽

Cited By ~ 11

Author(s):

B Yildizhan ◽

R Yildizhan ◽

B Ozkesici ◽

N Suer

Keyword(s):

Sensitivity And Specificity ◽

Uterine Fibroids ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Saline Infusion ◽

Transvaginal Ultrasonography ◽

Endometrial Polyps ◽

Menopausal Women ◽

Post Menopausal ◽

Saline Infusion Sonohysterography

This prospective study investigated 79 pre- and 25 post-menopausal women with abnormal uterine bleeding who underwent conventional transvaginal ultrasonography (TVS) and saline infusion sonohysterography (SIS) and compared the results with histopathological findings obtained by dilatation and curettage, hysteroscopy or hysterectomy. Histological examination revealed normal endometrial histology in 28 patients, intracavitary polyps in 46 patients, submucosal fibroids in 18 patients, intramural fibroids in six patients and endometrial hyperplasia in six patients. The sensitivity and specificity of TVS in detecting endometrial polyps were 65.2% and 87.9%, respectively, compared with 91.3% and 93.1% for SIS. The sensitivity and specificity of TVS in detecting uterine fibroids were 95.8% and 95.0%, respectively, versus 91.6% and 98.7% for SIS. These results show that SIS is a satisfactory method of identifying lesions and that it is easy and cost-effective, and improves on the diagnostic utility of TVS. SIS is also a less invasive alternative to hysteroscopy, so should result in less morbidity in the evaluation of abnormal uterine bleeding in women.

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A prospective study of comparison between transvaginal sonogram and histopathological examination in perimenopausal women with abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194609 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4233

Author(s):

P. Rishma Priyanka ◽

C. Rama Mani ◽

A. Yamuna

Keyword(s):

Histopathological Examination ◽

Endometrial Thickness ◽

Uterine Cavity ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Transvaginal Sonography ◽

Main Concern ◽

Dilatation And Curettage ◽

Perimenopausal Women ◽

Histopathological Report

Background: Abnormal uterine bleeding is one of the most frequently encountered conditions in gynaecology practice and forms about 10% of all gynaecological admissions, the main concern in perimenopausal bleeding is that the bleeding could be the only external manifestation of many hidden serious pathologies of uterine-cavity. The objective of this study was to compare the results of transvaginal sonography (TVS) and drug and cosmetic (D and C) with histopathological examination (HPE) report of hysterectomy specimen in perimenopausal women with AUB.Methods: A prospective comparative study where 100 perimenopausal women with AUB were subjected to TVS then D and C and then the results were compared with histopathological report of the hysterectomized specimen.Results: With an endometrial thickness less than or equal to 15 mm the histopathology report is normal endometrium. When the endometrial thickness more than or equal to 15 mm the histopathology report is hyperplasia or carcinoma. Findings of TVS correlated well with histopathological report after hysterectomy. 14 cases of adenomyosis, 16 cases of myomatous polyp, and 6 cases of endometrial polyp missed by dilatation and curettage.Conclusions: TVS is a simple, non-invasive test to indirectly visualize the endometrial cavity and is useful as a first step diagnostic procedure in the evaluation of perimenopausal bleeding. Dilatation and curettage lags in detecting adenomyosis, endometrial and myomatous polyps, When TVS combined with dilatation and curettage, it can supplement the shortcomings of dilatation and curettage.

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Association of thyroid dysfunction with abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182355 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2388

Author(s):

Lakshmi Manjeera M. ◽

Prabhneet Kaur

Keyword(s):

Thyroid Dysfunction ◽

Endometrial Thickness ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Thyroid Function Tests ◽

Medical College ◽

History Of ◽

Hormonal Steroids ◽

Thyroid Abnormalities ◽

Rule Out

Background: Abnormal uterine bleeding is a common complaint for women being referred to the gynaecologist and is associated with an array of symptoms. The objective of this study was to detect association of thyroid dysfunction in patients with menstrual irregularitiesMethods: This non-interventional prospective study was done over a period of one and half years in a private medical college in Mangalore. All patients in age group of 15-55 years who presented with history of menstrual disturbances were enrolled and evaluated in the study. Patients with structural causes of AUB or using IUCDs or hormonal steroids were excluded. Total of 85 patients were hence evaluated. These 85 patients were subjected to routine investigations like Hb, BT, CT and platelets (to rule out coagulation defects) along with TSH, T3, T4 estimation. Ultrasound abdomen and pelvis with endometrial thickness was done to rule out structural causes.Results: The most common menstrual disturbance was menorrhagia (47 patients: 55.3%). Thyroid abnormalities were found in 29 of the 85 patients with AUB (34.11%). Of the 29 patients with thyroid dysfunction, 24 were hypothyroid and 5 patients were found to be hyperthyroid.Conclusions: Thyroid abnormalities are frequently associated with menstrual irregularities. Hence Thyroid Function Tests are extremely valuable in patients with provisional diagnosis of AUB and should be made mandatory to avoid unnecessary hormonal or surgical treatment in such patients.

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A Case Report on Ayurvedic Management of Perimenopausal Bleeding

International Journal of Ayurveda and Pharma Research ◽

10.47070/ijapr.v9i11.2132 ◽

2021 ◽

pp. 87-89

Author(s):

Kavitha K S ◽

Aswini Mohan L ◽

Asha Sreedhar

Keyword(s):

Case Report ◽

Pap Smear ◽

Endometrial Thickness ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Transitional Period ◽

Excessive Bleeding ◽

Menstrual Cycles ◽

Flat Lesions ◽

Rule Out

Perimenopausal period is the transitional period where a woman passes from the reproductive to the non-reproductive stage. Abnormal uterine bleeding in the perimenopausal period accounts for 70% of all gynecological problems. Most of the abnormal uterine bleeding in this period is due to endometrial abnormalities. In Ayurveda the condition can be correlated to Asrigdhara. This is the case report of a 54 year aged lady who presented with complaints of excessive bleeding and frequent menstrual cycles since three months. Investigations were done to rule out malignancy. USG report showed endometrial hyperplasia of 17mm with bulky uterus. Pap smear and Colposcopy reports showed inflammatory and CIN I changes with HPV flat lesions respectively. Bleeding stopped after two weeks of internal medication. USG done after six months showed significant reduction in endometrial thickness. Pronounced changes were also seen in Pap smear and Colposcopy findings.

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Comparison of transvaginal sonography with hysteroscopy and correlation with histopathological report in case of abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180199 ◽

2018 ◽

Vol 7 (2) ◽

pp. 710

Author(s):

Gunadhar Maiti ◽

Prasad Lele ◽

Dhananjay Borse

Keyword(s):

Sensitivity And Specificity ◽

Endometrial Hyperplasia ◽

Endometrial Thickness ◽

Tertiary Care ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Transvaginal Sonography ◽

Lower Sensitivity ◽

Age Group ◽

Histopathological Report

Background: Abnormal uterine bleeding (AUB) is change in frequency of menses, duration of flow or amount of blood loss. The objectives of the present study were to determine and compare the diagnostic accuracy of TVUS (Transvaginal ultrasonogrphy) with hysteroscopy for diagnosis of endometrial and intramyometrial pathology in case of abnormal uterine bleeding, to study the correlation with histopathological report of endometrial biopsyMethods: It was a prospective comparative study. 200 cases of AUB were selected from June 2010 to May 2012 attending Gynaecology OPD in tertiary care level public sector teaching hospital at Mumbai, meeting the selection criteria were enrolled into the study. Complete history, detail general, systemic and local examination was performed for all patients. Two-dimensional transvaginal ultrasonography was performed to see for endometrial or intramyometrial pathology. Endometrial thickness was noted for all patients. Hysteroscopy and D&C was performed within 48 hours of ultrasonography. After hysteroscopy, curettage was performed and sent for histopathological examination.Results: TVUS detected, 19 polyps (9.5%) and 81 myomas. It was able to differentiate these myomas as 64 interstitials (32%) and 17 submucous (8.5%) hysteroscopy detected 26 submucous myomas (13%), 31 polyps (15.5%), endometrial hyperplasia detected by TVUS, 19 in premenopausal and 06 in postmenopausal age group. Hysteroscopy detected 24 in premenopausal and 06 in post-menopausal age group. Histopathology of endometrial biopsy it came positive for 13 in premenopausal and 08 in postmenopausal age group. Two cases of CA endometrium were diagnosed on HPE out of which one was diagnosed by TVUS and same was diagnosed by hysteroscopy. Conclusions: TVUS has significantly lower sensitivity but comparable specificity with hysteroscopy in diagnosing endometrial polyp and submucous fibroid, comparable sensitivity and specificity in diagnosing endometrial hyperplasia, equivalent sensitivity and specificity in diagnosing endometrial carcinoma, accuracy of TVUS for detecting pathology in AUB is comparable to hysteroscopy, suitable for developing countries as first diagnostic step for AUB.

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Role of Transvaginal Ultrasonography in Diagnosing Endometrial Hyperplasia in Postmenopausal Women with Abnormal Uterine bleeding taking Histopathology as Gold Standard

10.53350/pjmhs211561229 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1229-1230

Author(s):

S. Bilal ◽

M. Gulshan ◽

M. Tahir

Keyword(s):

Diagnostic Accuracy ◽

Gold Standard ◽

Endometrial Hyperplasia ◽

Endometrial Thickness ◽

False Negative ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Transvaginal Ultrasonography ◽

Post Menopause ◽

Post Menopausal

Aim: Diagnostic accuracy of transvaginal ultrasonography in diagnosing endometrial hyperplasia in post-menopausal women with abnormal uterine bleeding taking histopathology as gold standard. Settings & duration: Department of Radiology, CMH, Rawalpindi from 25-08-17 to 24-02-18 Methodology: A total of 203 post-menopausal females having AUB were included. Patients who had cervical and vaginal pathologies other than EH were excluded. The ultrasound was done with Endovaginal probe of Toshiba aplio 500. On ultrasound, endometrial thickness was taken. Endometrial biopsy was carried out using hysteroscopy. Final diagnosis was based upon histopathology report. Results: In TVS positive patients, 103 were True Positive and 12 were False Positive. Among 88 TVS negative patients, 04 were False Negative whereas 84 were True Negative (p=0.01). Overall sensitivity, specificity, PPV, NPV and diagnostic accuracy of transvaginal ultrasonography in diagnosing endometrial hyperplasia in post-menopause women with abnormal uterine bleeding taking histopathology as gold standard was 96.3%, 87.5%, 89.6%, 95.5% and 92.1% respectively. Conclusion: Diagnostic accuracy of TVS in diagnosing endometrial hyperplasia in post-menopause women with AUB is high, so TVS should be the first line investigation in diagnosis of endometrial hyperplasia. Keywords: Abnormal uterine bleeding, TVS, endometrial hyperplasia

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