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 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 Correlation of Clinical Presentations with Endometrial Pathologies in Women Presenting with Abnormal Uterine Bleeding. A Prospective Descriptive Study

2018 ◽  
Vol 3 (1) ◽  
pp. 354-356
Author(s):  
Pritha Basnet ◽  
Achala Thakur ◽  
Ajay Agrawal ◽  
Sangeeta Bhandari ◽  
Sarita Sitaula ◽  
...  
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Descriptive Study ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Endometrial Sampling ◽  
Presenting Symptoms ◽  
Clinical Presentations ◽  
Proliferative Endometrium ◽  
Diagnostic Step ◽  
Endometrial Pathology

Introduction: Abnormal uterine bleeding (AUB) is one of the common presenting symptoms in women attending gynaecology outpatient department and has remained one of the most frequent indications for hysterectomy in developing countries. Endometrial sampling is used as the first diagnostic step in AUB.Objectives: To correlate the clinical presentations with endometrial pathologies in women presenting with abnormal uterine bleeding.Methodology: This was a hospital based descriptive study carried out on one hundred and nineteen women who presented with AUB and planned for endometrial biopsy. Clinical profile of the patient was recorded and the histopathology of the sampled endometrial tissue was retrieved. Correlation of abnormal uterine bleeding with histopathology report was done using appropriate statistical test.Results: The mean age of presentation of women with abnormal uterine bleeding was 46.56 yrs ± 9.525. Irregular menstrual cycle was the commonest reason seeking treatment for AUB. The commonest histopathology among women who underwent endometrial biopsy was secretory endometrium (39.5%). Other causes identified were proliferative endometrium (21.8%), mucus flakes with hemorrhage (16%), disordered proliferative endometrium (10%), pill endometrium (5%) ,endometritis (5.9%), endometrial carcinoma (1.7%),endometrial hyperplasia without atypia (1.7%).Conclusion: The nature of endometrial pathology is varied across the entire spectrum of women presenting with abnormal uterine bleeding. Knowledge of endometrial pathology helps in directing specific management and can provide better care to women presenting with abnormal uterine bleeding. BJHS 2018;3(1)5 : 354-356

Etiological structure and diagnosis of abnormal uterine bleeding

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (2) ◽  
pp. 14-17
Author(s):  
G E Chernukha ◽  
I A Ivanov ◽  
Z N Efendieva ◽  
M R Dumanovskaya ◽  
A V Asaturova
Keyword(s):  
Diagnostic Accuracy ◽  
Endometrial Hyperplasia ◽  
Ultrasound Examination ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Histological Diagnosis ◽  
Reproductive Age ◽  
Endometrial Polyps ◽  
Chronic Endometritis ◽  
Endometrial Pathology

Abnormal uterine bleeding (AUB) is one of the most common indications for hysteroscopy. Most of the AUB cases occur due to endometrial or myometrium pathology. Among it, endometrial polyps (EP) and chronic endometritis (CE) prevalent in reproductive age, while endometrial hyperplasia (EH) and EP dominate in perimenopause. It was determined that EP and CE are characterized with menorrhagia and metrorrhagia approximately equally, whereas EH reveals AUB with oligomenorrhoea. Verification of exact endometrial pathology by ultrasound examination is hindered, that results in deviations of ultrasound and histological diagnosis. The usage of ultrasound data and AUB’s characteristics may improve the diagnostic accuracy on preadmission period.

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

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.

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.

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 Does Transvaginal Ultrasonography Have Good Diagnostic Value in Endometrial Pathology?

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Moradan S ◽  
Ghorbani R ◽  
Far M
Keyword(s):  
Endometrial Thickness ◽  
Diagnostic Value ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Transvaginal Ultrasonography ◽  
Predictive Values ◽  
Menopausal Women ◽  
Post Menopausal ◽  
Abnormal Pathology ◽  
Endometrial Pathology

Introduction: Endometrial biopsy is usually considered unnecessary in post-menopausal uterine bleeding when the endometrial thickness (ET) is less than 5 mm because the risk of endometrial hyperplasia or cancer is low. However, there is still much controversy from this as some believe that the diagnostic value of ET in diagnosis of endometrial pathology (EP) in postmenopausal bleeding is necessary. In this study, the diagnostic value of ET for diagnosis of EP in post-menopausal bleeding was evaluated. Materials and methods: Sixty post-menopausal women with uterine bleeding were evaluated. Transvaginal ultrasonography (TVS) was used for measurement of ET followed by dilatation and curettage in a one-day interval. According to the EP, patients were divided in two groups, normal and abnormal. Endometrial atrophy was considered as normal and hyperplasia, polyps and carcinoma was considered as abnormal. Results: Twenty nine cases had ET more than 6 mm, among them, 25 cases had abnormal pathology (hyperplasia, polyp, cancer) and 4 cases were normal (atrophy). Thirty-one patients had ET equal or less than 6mm, among them, 26 cases were normal (atrophy) and 5 cases had abnormal pathology. The sensitivity, specifi ty, positive and negative predictive values of TVS in the diagnosis of uterine pathology were 83.3%, 86.7%, 86.2%, 83.9% respectively. Conclusion: We suggest that an ET of less than 6 mm in TVS is unlikely to indicate EP in post-menopausal women with uterine bleeding.

Sign in / Sign up

Export Citation Format

Share Document