The Correlation of the IETA Ultrasound Score with the Histopathology Results for Women with Abnormal Bleeding in Western Romania

In the early differential diagnosis of endometrial cancer (EC), decisive and mandatory histological aspects are considered, in addition to obvious clinical manifestations. In addition, sonographic aspects are characteristic in relation to the stage, degree, and histological types of identified cancer. This bi-center retrospective observational study included 594 women with abnormal uterine bleeding outside pregnancy, for which a biopsy was performed in the Obstetrics and Gynecology Departments of the Emergency County Hospitals of Arad and Timis Counties, Romania, between 2015 and 2019. Most of the cases were represented by EC or endometrial hyperplasia (EH). Of the 594 cases, 25.5% (n = 153) were EC at women aged between 41 and 85 years. High International Endometrial Tumor Analysis (IETA) scores (3, 4) were associated with a relative risk of 2.9335 compared with other endometrial lesions (95% CI 2.3046 to 3.734, P < 0.0001, NNT 1.805). Histological aspects and pelvic ultrasound using IETA scores represent valuable noninvasive assets in diagnosing and differentiating endometrial cancer from benign uterine pathology.

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Correlation of body mass index and abnormal uterine bleeding in premenopausal women

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204826 ◽

2020 ◽

Vol 9 (11) ◽

pp. 4640

Author(s):

Kumarasamy Akalyaa ◽

Pattacheravanda Nanaiah Shakuntala ◽

Ramaiah Renuka

Keyword(s):

Body Mass Index ◽

Endometrial Cancer ◽

Body Mass ◽

Endometrial Hyperplasia ◽

Premenopausal Women ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Significant Difference ◽

Menstrual Patterns ◽

The Mean

Background: As the rate of obesity is increasing in women in the recent years, the incidence of endometrial cancer increases as the body mass index (BMI) increases. Despite the clear evidence linking endometrial cancer and obesity, there is limited public awareness of this relationship. This study was undertaken to evaluate the association of BMI and endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB).Methods: An analytical case control study was conducted in 100 women between the age group of 40 to 55, with AUB in the Department of Obstetrics and Gynecology, ESIC-PGIMSR Bangalore between January 2018 and June 2019. The menstrual patterns and endometrial pattern by histopathology were analysed in women with BMI of 18.5 to 24.99 and ≥25.Results: The mean age of women participated in the study group of between 40- 55 years was 44.83. The mean duration of symptoms was 10.18 months in the cases group and 8.52 months in the control group. The menstrual patterns were comparable and there was no significant difference in both the groups. The mean endometrial thickness, mean BMI, hyperplasia with or without atypia were all higher in the cases group. The frequency of occurrence of atypical endometrial hyperplasia was higher in women with increasing BMI.Conclusions: We found increased BMI to be an important independent risk factor for the development of endometrial hyperplasia with atypia which is a precursor to endometrial carcinoma in premenopausal women with AUB.

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Relação entre o espessamento endometrial e o sangramento uterino anormal no diagnóstico de câncer de endométrio em pacientes na pós-menopausa / Relationship among endometrial thickening and abnormal uterine bleeding in the diagnosis of endometrial cancer in postmenopausal patients

Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo ◽

10.26432/1809-3019.2019.64.3.208 ◽

2019 ◽

Vol 64 (3) ◽

pp. 208

Author(s):

Carmen Mayanna Jamur ◽

Grace Kelly Rodrigues ◽

Eduardo Schunemann Junior

Keyword(s):

Endometrial Cancer ◽

Gynecological Cancer ◽

Abnormal Uterine Bleeding ◽

Total Sample ◽

Uterine Bleeding ◽

Incidence Of Cancer ◽

Endometrial Thickening ◽

Uterine Curettage ◽

Abnormal Bleeding ◽

The Relationship

Introdução: O câncer de endométrio é o terceiro câncer ginecológico mais frequente em mulheres no Brasil. O sangramento uterino anormal e o espessamento endometrial são as apresentações mais comuns da doença. O objetivo desse estudo foi encontrar a relação entre sangramento, espessamento endometrial e obesidade no diagnóstico do câncer de endométrio na paciente na pós-menopausa. Métodos: Trata-se de um estudo retrospectivo no qual foi realizado o levantamento de dados das pacientes na pós-menopausa submetidas à curetagem uterina de prova (CUP) devido à queixa de sangramento anormal e/ou apresentarem espessamento endometrial, no Hospital de Clínicas da UFPR no período de Janeiro de 2012 a Dezembro de 2014. Resultados: Das 157 pacientes na pós-menopausa avaliadas, foram diagnosticados 33 casos de câncer de endométrio e dois de sarcoma. Da amostra total (157), 112 apresentavam espessamento endometrial e sangramento, 40 somente espessamento e 5 somente sangramento. Das 112 com sangramento e espessamento, foram encontrados 31 (27,7%) casos de câncer de endométrio. Das 40 que apresentavam apenas espessamento, uma (2,5%) apresentou câncer. Das 5 que apresentavam sangramento isolado, foi diagnosticado um caso de câncer de endométrio (20%). A incidência de câncer de endométrio também mostrou relação com o aumento de IMC (com maior incidência acima de 25) e com o nível de espessamento endometrial a partir de 15mm. Conclusão: O sinal mais importante relacionado ao câncer de endométrio, sem dúvida é o sangramento. Mulher no período da pós-menopausa que apresente sangramento uterino anormal deve ser investigada criteriosamente em busca de exclusão de diagnóstico oncológico, pela alta possibilidade (OR = 14.03) de ter câncer de endométrio.Descritores: Neoplasias do endométrio, Metrorragia, Hemorragia uterina, Pós-menopausa, Obesidade, CuretagemAbstractIntroduction: Endometrial cancer is one of the most common types of gynecological cancer, and it is the fourth leading cause of death by cancer among women in Brazil. Abnormal uterine bleeding and endometrial thickening are the most frequent presentations of this disease. The objective of this study was to find the relationship among abnormal bleeding, thickening and obesity in the diagnosis of endometrial cancer in postmenopausal patients. Methods: This is a retrospective study in which was collect data of patients that underwent uterine curettage (D&C) complaining about abnormal bleeding and/or presenting endometrial thickening, at Hospital de Clínicas from UFPR on the period of January 2012 to December 2014. Results: From all the 157 postmenopausal patients evaluated, 33 cases of endometrial cancer and two of sarcoma were diagnosed. In the total sample (157), 112 presented endometrial thickening and bleeding, and 40 presented thickening and five presented isolated bleeding. Within the 112 patients with abnormal bleeding and endometrial thickening, 31 (27.7%) cases of endometrial cancer were found. From the 40 patients with only thickening, one (2.5%) presented cancer. From the five patient isolated bleeding, one (20%) case of endometrial cancer was diagnosed. The incidence of cancer also showed relationship with BMI increasing (mores incidence of cancer with BMI over 25) and with endometrial thickening starting from 15mm. Conclusion: The most important factor related to endometrial cancer beyond doubt is abnormal bleeding. Postmenopausal women with abnormal uterine bleeding should be carefully investigated for exclusion of an oncological diagnosis, because of the high possibility (OR = 14.03) of having endometrial cancer.Keywords: Endometrial neoplasms, Metrorrhagia, Postmenopause, Uterine hemorrhage, Obesity, Curettage

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Etiological structure and diagnosis of abnormal uterine bleeding

GYNECOLOGY ◽

10.26442/2079-5696_2018.2.14-18 ◽

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.

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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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Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems

Diagnostics ◽

10.3390/diagnostics11030442 ◽

2021 ◽

Vol 11 (3) ◽

pp. 442

Author(s):

Norbert Stachowicz ◽

Agata Smoleń ◽

Michał Ciebiera ◽

Tomasz Łoziński ◽

Paweł Poziemski ◽

...

Keyword(s):

Endometrial Cancer ◽

Endometrial Hyperplasia ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Menopausal Status ◽

Power Doppler ◽

Uterine Cavity ◽

Abnormal Uterine Bleeding ◽

Scoring Systems ◽

Diagnostic Challenge

Background: Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. Aim: The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. Material and methods: It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. Results: The median age was 60.3 years (range ±10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71–0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65–0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70–0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73–0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. Conclusions: New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.

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Hysteroscopic evaluation in infertility and abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180181 ◽

2018 ◽

Vol 7 (2) ◽

pp. 612

Author(s):

Navneet Kaur ◽

Ruby Bhatia ◽

Paramjit Kaur ◽

Surinder K. Bhopal

Keyword(s):

Endometrial Hyperplasia ◽

Uterine Cavity ◽

Invasive Procedure ◽

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Therapeutic Modality ◽

Secondary Infertility ◽

Endometrial Polyps ◽

Submucous Fibroid

Background: Hysteroscopy an endoscopic procedure for visualization of uterine cavity may be extensively used in both primary and secondary infertility and abnormal uterine bleeding for evaluating intrauterine pathology. The objectives of this study were to visualize and identity intrauterine pathology in both primary and secondary infertility and abnormal uterine bleeding (AUB) by hysteroscopic evaluation and to perform hysteroscopic guided therapeutic procedures like endometrial currettage, polypectomy, adhesiolysis.Methods: Hysteroscopic evaluation of uterine cavity for any intrauterine pathology in AUB and Infertility. Adhesiolysis, polypectomy, endometrial biopsy misplaced copper T removal were carried out under hysteroscopic vision.Results: Intrauterine synechia in 20.51%, Submucous fibroid in 5.13%, bicornuate uterus, endometrial hyperplasia and endometrial polyp were seen in 2.56% patient each were detected in infertility group while 81.95% cases with AUB had abnormal intrauterine pathology commonest being endometrial hyperplasia in 33.33% followed by endometrial polyps in 23.81% cases, submucous fibroid and misplaced copper T in 9.52% each and intrauterine synechia in 4.76% patient. Endometrial biopsy and polypectomy was done in 23.80% each with AUB, misplaced copper T removal in 9.52% and adhesiolysis in 4.76% patient with AUB.Conclusions: Hysteroscopy remains gold standard for evaluating intrauterine lesions in abnormal uterine bleeding and infertility. A safe, simple minimally invasive procedure not only diagnostic but therapeutic modality for adhesiolysis, endometrial biopsy/curettage, polypectomy, misplaced copper T removal under direct vision with minimal complication within reach of every Gynaecologist thereby reducing burden of major surgical intervention.

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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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