Examining the Association between Endometrial Thickness
in Transvaginal Ultrasound and Results of Pipelle Endometrial
Sampling in Perimenopausal Women with Abnormal Uterine Bleeding

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

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1212 ◽

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.

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

Obstetrics and Gynecology International ◽

10.1155/2022/5073944 ◽

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.

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Endometrial Volume Measured by VOCAL Compared to Office Hysteroscopy for Diagnosis of Endometrial Polyps in Premenopausal Women with Abnormal Uterine Bleeding

Obstetrics and Gynecology International ◽

10.1155/2016/3561324 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Mohamed Laban ◽

Sherif H. Hussain ◽

Alaa S. Hassanin ◽

Waleed M. Khalaf ◽

Mohamed K. Etman ◽

...

Keyword(s):

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Premenopausal Women ◽

Abnormal Uterine Bleeding ◽

Final Analysis ◽

Uterine Bleeding ◽

Endometrial Polyps ◽

Predictive Values ◽

Endometrial Volume ◽

Sensitivity Specificity

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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Histopathological evaluation of endometrial sampling in perimenopausal women with abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212977 ◽

2021 ◽

Vol 10 (8) ◽

pp. 3180

Author(s):

Bhavani L. Nair ◽

Lency S. Kuriakose

Keyword(s):

Endometrial Cancer ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Menstrual Bleeding ◽

Endometrial Sampling ◽

Medical College ◽

Perimenopausal Women ◽

Proliferative Endometrium ◽

Secretory Endometrium

Background: Abnormal uterine bleeding (AUB) is one of the common symptoms in the gynaecology outpatient department. About one third of women are affected at some time in their lives. The perimenopausal women show significant number of underlying organic pathology. The evaluation of endometrium and/or organ histopathology has the dual advantage of finding the cause of AUB and to rule out endometrial cancer or the potential for cancer in future like endometrial hyperplasia with atypia. The aim of the study was to determine the histopathological pattern of endometrial sampling in perimenopausal women with AUB and to follow them up for a period of six months after the procedure.Methods: The prospective observational study was conducted at the department of obstetrics and gynaecology at Sree Gokulam Medical College and Research Foundation, Venjaramood, Thiruvananthapuram, Kerala, for a period of one year from December 2019 to December 2020. The study was conducted on 116 perimenopausal women 41-52 years who presented with AUB and had undergone endometrial sampling. These ladies were subsequently followed up for six months post procedure to assess the response to medical treatment or the need for any surgical intervention like hysterectomy.Results: A total 39.65% patients had heavy and prolonged menstrual bleeding and 18.16% patients had irregular bleeding. 14.65% patients had prolonged flow, 8.6% had heavy flow, 6.8% had infrequent with prolonged flow, 6% had prolonged, infrequent with heavy bleeding. Non-structural (COEIN) causes contributed to about 60.4% of AUB in perimenopausal women and 39.6% had structural (PALM) causes. 49% cases were secretory endometrium. 29.3% had disordered proliferative endometrium, 4.3% had proliferative endometrium, 5.2% each had polyp or hyperplasia without atypia. 18 (15.5%) cases underwent hysterectomy, 3 patients who had adenocarcinoma underwent staging laparotomy, 2 patients had LNG IUS insertion and 40 patients were on follow up requiring either no treatment and 53 (45.68%) patients were given antifibrinolytics or hormonal therapy.Conclusions: Heavy and prolonged menstrual bleeding was the most common presenting symptom. COEIN contributed to about 60.4% of cases. Evaluation of the endometrium showed that, secretory endometrium was commonest (49%) followed by disordered proliferative endometrium (29.3%). On follow up for six months, 15.5% patients underwent hysterectomy, 2 patients had insertion of levonorgestrel IUD, 45.68% patients had medical management with antifibrinolytics or hormones and were on follow up. The responsibility of gynaecologist in the management of AUB in perimenopausal women is to exclude hyperplasia of endometrium and endometrial cancer.

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194608 ◽

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.

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Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Turkish women with abnormal uterine bleeding

Journal of Obstetrics and Gynaecology Research ◽

10.1111/jog.12937 ◽

2016 ◽

Vol 42 (5) ◽

pp. 573-578 ◽

Cited By ~ 5

Author(s):

Alev Ozer ◽

Serdar Ozer ◽

Mine Kanat-Pektas

Keyword(s):

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Turkish Women ◽

Histopathological Findings

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Perimenopausal women presenting with abnormal uterine bleeding: Endometrial thickness

International Journal of Clinical Obstetrics and Gynaecology ◽

10.33545/gynae.2021.v5.i6b.1063 ◽

2021 ◽

Vol 5 (6) ◽

pp. 98-100

Author(s):

Dr. Noor Ayesha Begum ◽

Dr. Anil Kumar GV ◽

Dr. Lokesh Chandra HC

Keyword(s):

Endometrial Thickness ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Perimenopausal Women

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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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A STUDY OF CLINICAL CORRELATION WITH HISTOPATHOLOGICAL DIAGNOSIS OF ABNORMAL UTERINE BLEEDING AT JLNMCH, BHAGALPUR, BIHAR

10.36106/ijsr/2632845 ◽

2021 ◽

pp. 73-74

Author(s):

Archana Jha ◽

Satyendra Kumar ◽

[Prof.] Usha Kumari ◽

Debarshi Jana

Keyword(s):

Clinical Diagnosis ◽

Histopathological Examination ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Clinical Impression ◽

Histopathological Diagnosis ◽

Endometrial Sampling ◽

Carcinoma Of Cervix ◽

Perimenopausal Women ◽

Pathological Evaluation

Background: Abnormal uterine bleeding in perimenopausal women accounts for about 70% of gynaecologic Outpatient Department visits. Perimenoppause, also called the menopausal transition, is the interval in which a woman's body makes a natural shift from more or less regular cycles of ovulation and menstruation toward permanent infertility, or menopause. Polymenorrhagia, intermenstrrual bleeding and metrorrhagia are other common disorders at perimenopause. Endometrial sampling is a safe and effective diagnostic step in evaluation of abnormal uterine bleeding after ruling out medical causes. The present study was aimed to review the causes of abnormal uterine bleeding in perimenopausal women establishing the correlation with clinical diagnosis and histopathological examinations. A total of 150 perimenopausal Material and Methods: women with abnormal uterine bleeding in the age group of 37-51 years for a period of 6 months were included. These women were evaluated clinically and ultrasonographically for the cause of abnormal uterine bleeding. Clinical impression and USG reports were correlated. These women underwent dilatation and curettage for endometrial sampling and specimen sent for histopathological examination. Histopathological reports were correlated with clinical diagnosis. Most of the patients with AUB were Results: between 37-41 years of age (56%). The incidence was high in parity-3 (26%) annd grand multipara (49.33%). The majority of the women were presented with menorrhagia (54.66%). Clinically, majority of the cases were diagnosed as broids 66 (44%) followed by dysfunctional uterine bleeding (DUB) 56 (37.33%). However, histopathological reports conrmed broid in 52 cases, DUB in 49, adenomyosis in 36 and polyp in 11 cases. Fibroi Discussion: ds are common nding in women with menorrhagia. Clinical, radiological and pathological evaluation correlated very well to diagnose broids and DUB. However clinically as well USG proved of little help to diagnose adenomyosis and carcinoma of cervix and endometrium. Thus, histopathological evaluation of endometrium is recommended in perimenopausal women.

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