scholarly journals Hysteroscopy—A Mode of Screening Women with Postmenopausal Bleeding: Our Experience

2011 ◽  
Vol 3 (1) ◽  
pp. 10-13 ◽  
Author(s):  
Sejal Naik ◽  
Pooja Lodha ◽  
Sunita Tandulwadkar ◽  
Bhavana Agarwal ◽  
Prashant Deshmukh
Keyword(s):  
Gold Standard ◽  
Endometrial Hyperplasia ◽  
Transvaginal Sonography ◽  
Histopathological Diagnosis ◽  
Postmenopausal Bleeding ◽  
Benign Lesions ◽  
Study Objective ◽  
Sonographic Evaluation ◽  
Precise Diagnosis ◽  
Histopathological Results

ABSTRACT Study Objective 1. To study the etiology of postmenopausal bleeding. 2. To study the significance of hysteroscopy in evaluation of the etiopathogenic factors. 3. Correlating the diagnosis after transvaginal sonography (TVS), hysteroscopy and histopathology. 4. Feasibility of conservative management with hysteroscopy in postmenopausal bleeding. Design Prospective study from January 2009 to June 2010. Setting Department of Obstetrics and Gynecology of Ruby Hall Clinic, Pune, Maharashtra, India. Sample size Sixty postmenopausal women with complaint of bleeding per vaginum. Interventions Clinical and sonographic evaluation followed by diagnostic and/or therapeutic hysteroscopy and guided biopsy. Hysteroscopic images were analyzed and compared with histopathological results. Measurements and main results On hysteroscopy, endometrium is classified as suggestive of normal, atrophic, endometrial hyperplasia or endometrial carcinoma. Histopathological diagnosis was taken as a gold standard to determine the efficacy of hysteroscopy in diagnosing endometrial pathologies. The sensitivity and specificity of hysteroscopy in diagnosing endometrial pathologies was assessed. Conclusions In women with postmenopausal bleeding, hysteroscopy is a valuable tool that allows precise diagnosis of various endouterine pathologies. In our study, the sensitivity of hysteroscopy was 97% and the specificity was 98.66%. Hence, we can conclude that it is highly accurate for evaluating endometrial pathologies. For obvious benign lesions, it also provides treatment in the same sitting, therefore avoiding an extensive, morbid, and expensive procedure like hysterectomy.

scholarly journals Evaluation of endometrial causes of postmenopausal bleeding with it's correlation with endometrial thickness and hysteroscopy findings and endometrial tissue histopathology

2020 ◽  
Vol 9 (7) ◽  
pp. 2940
Author(s):  
Saurabh V. Bhangale ◽  
Shailja Sharma ◽  
Asmita Patil ◽  
Beena Kumari
Keyword(s):  
Diagnostic Accuracy ◽  
Endometrial Carcinoma ◽  
Predictive Value ◽  
Histopathological Examination ◽  
Endometrial Thickness ◽  
Endometrial Tissue ◽  
Transvaginal Sonography ◽  
Histopathological Diagnosis ◽  
Postmenopausal Bleeding ◽  
Dilation And Curettage

Background: Postmenopausal bleeding (PMB)accounts for 5% of gynecology visit. All with unexpected uterine bleeding should be evaluated for endometrial carcinoma since this potentially lethal disease is the cause of bleeding in approximately 10 percent patients (range 1 to 25 percent, depending upon risk factors). The aim of the study was to evaluate endometrial causes of postmenopausal bleeding (PMB) with it's correlation with endometrial thickness (ET)and hysteroscopy findings and endometrial tissue histopathology.Methods: A total 50 consecutive cases of PMB fulfilling the inclusion and exclusion criteria and giving informed consent were selected. Each patient was subjected to transvaginal sonography (TVS) in which uterus, adnexa and endometrial thickness (ET) was assessed. Then hysteroscopy and/or dilation and curettage was scheduled at subsequent visit. Endometrial sample was sent for histopathological examination. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for ET by TVS and hysteroscopy findings, considering histopathological diagnosis as the gold standard.Results: Most common endometrial cause of PMB was atrophic endometrium (44%). The other causes were endometrial carcinoma (18%), endometrial hyperplasia (18%), endometrial polyp (12%), endometritis (4%), and leiomyoma (4%). The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%.Conclusions: Being relatively cheap, easily accessible, non-invasive, TVS with ET measurement should first line investigation in the evaluation of women with postmenopausal bleeding with suspected endometrial pathology. Although hysteroscopy is more specific and sensitive, in poor resource settings it should be limited to cases with ill-defined endometrial lining, recurrent/ persistent bleeding and cases with endometrial thickness greater than 5 mm irrespective of endometrial echotexture.

scholarly journals Hysteroscopy: an effective tool in post-menopausal bleeding

2018 ◽  
Vol 8 (1) ◽  
pp. 159
Author(s):  
K. K. Junnare ◽  
G. J. Desai ◽  
G. S. Shekhawat
Keyword(s):  
Vaginal Bleeding ◽  
Endometrial Hyperplasia ◽  
Endometrial Thickness ◽  
Transvaginal Sonography ◽  
Postmenopausal Bleeding ◽  
Diagnostic Modalities ◽  
Post Menopausal ◽  
Histopathology Examination ◽  
Endometrial Pathology ◽  
Vaginal Ultrasonography

Background: Postmenopausal bleeding is a condition where endometrial carcinoma is to be ruled out. Traditionally, D and C is the preferred method for diagnosis in such condition. Other diagnostic modalities like trans vaginal ultrasonography (TVS) and hysteroscopy are being used for diagnosis in the cases of PMB. The objective of this study is to evaluate the efficacy and accuracy of TVS and hysteroscopy in women with postmenopausal bleeding (PMB).Methods: One hundred postmenopausal women with vaginal bleeding underwent TVS and hysteroscopy. Endometrial tissue was obtained by curettage and sent for histopathology examination. The results of TVS and Hysteroscopy were compared against HP report.Results: Hysteroscopy was successful in 98 patients. Endometrial histopathology revealed proliferative, secretory and atrophic endometrium in 26, 7 and 23 patients respectively. Polyp was diagnosed in 13 patients. Endometrial hyperplasia was detected in 11 patients and endometrial malignancy in 14 patients. All patients with endometrial hyperplasia and malignancy had ET (endometrial thickness) more than 4 mm, except one patient with endometrial malignancy who had 4 mm ET. The sensitivity and specificity of TVS for suspecting endometrial pathology at ET 4mm were 93% and 69.6%, respectively. Hysteroscopy had sensitivity of 95.2%, specificity of 92.8%, with diagnostic accuracy of 93.8%.Conclusions: Hysteroscopy was found to be the more sensitive and specific than Transvaginal sonography for diagnosing endometrial pathologies. Hysteroscopy is safe and effective for detecting endometrial pathologies in patients with PMB.

scholarly journals Role of diagnostic hysteroscopy in evaluation of postmenopausal bleeding

2019 ◽  
Vol 8 (11) ◽  
pp. 4182
Author(s):  
Nisha Solanki ◽  
Prashant Suryarao ◽  
Aditi Bhatnagar
Keyword(s):  
Predictive Value ◽  
Gold Standard ◽  
Abnormal Uterine Bleeding ◽  
Transvaginal Sonography ◽  
Postmenopausal Bleeding ◽  
Medical College ◽  
Diagnostic Hysteroscopy ◽  
Sensitivity Specificity ◽  
Follicular Activity

Background: Postmenopausal bleeding is defined as permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Incidence of abnormal uterine bleeding is 10% to 15% in postmenopausal bleeding. For evaluation of postmenopausal bleeding earlier dilatation and curettage was considered as gold standard which is a blind procedure, transvaginal sonography has improved the accuracy of endometrial morphology. Now the focus has shifted to hysteroscopic guided biopsy which is gold standard for evaluating postmenopausal bleeding it also has benefit of see and treat modality. The objective of this study was to study the significance of hysteroscopy in diagnosis of etiopathological factors of postmenopausal bleeding. To correlate the diagnosis by TVS, hysteroscopy and histopathological diagnosis.Methods: The study was conducted at Dr. D. Y. Patil Medical College and Hospital from June 2016 to September 2018. A total of 30 cases were evaluated. The commencement of the study was followed by approval of the institutional ethical committee.Results: In our study, 83.34% of patients with postmenopausal bleeding where in age group menopause is >55 years. 66.67% are overweight with BMI of 25-29.9. We evaluated the ET <4 mm, 4-12 mm, >12 mm thickness, 53.33% were between 4-12 mm of ET. In our study endometrial hyperplasia shows 30% in hysteroscopy, on HPE shows 33.33%, in atrophic endometrium 20% on HPE is also 20%, polyp shows 6.67% in both hysteroscopy and HPE, sub mucous myoma on both hysteroscopy and HPE shows 3.33% and Ca endometrium shows 3.33% in both hysteroscopy and HPE.Conclusions: Study of total 30 cases were conducted, by using Bettochi Office hysteroscope (2.9 mm). Sensitivity, specificity, positive predictive value and negative predictive value of hysteroscopy was calculated in each group of patients.

scholarly journals Hysteroscopy versus transvaginal ultrasonography: finding the better modality for evaluation of postmenopausal bleeding

2019 ◽  
Vol 8 (4) ◽  
pp. 1568
Author(s):  
Mishika Bhoj ◽  
Shakti Kumar Yadav
Keyword(s):  
Screening Method ◽  
Disease Free Survival ◽  
Endometrial Biopsy ◽  
Transvaginal Ultrasonography ◽  
Transvaginal Sonography ◽  
Histopathological Diagnosis ◽  
Postmenopausal Bleeding ◽  
Current Standard ◽  
Endometrial Polyps ◽  
Sensitivity Specificity

Background: The most common cause of postmenopausal bleeding is benign pathology, but likelihood of malignancy must be promptly excluded. As excision of localized lesion has higher disease-free survival rate and lower morbidity as opposed to treatment for regional-stage disease. Commonly employed blind dilatation and curettage followed by histopathology is the current standard. A screening method with high sensitivity and specificity can help to prevent the invasive procedure and can also improve the accuracy of the biopsy. The objective of the present study was to study and compare the diagnostic accuracy of hysteroscopy and transvaginal ultrasonography in diagnosis of postmenopausal bleeding.Methods: 80 female patients with complaints of postmenopausal bleeding were enrolled and followed up for a period of 10 months. Each patient underwent transvaginal ultrasonography and hysteroscopy followed by endometrial biopsy. Result were analyzed to find sensitivity, specificity, accuracy, PPV and NPV taking histopathological diagnosis as gold standard.Results: Authors found that in 40 patients (50%), the cause of post-menopausal bleeding was caused atrophic endometrium followed by endometrial hyperplasia seen in 14 patients (17.5%). Hysteroscopy had higher overall sensitivity, specificity, NPV and accuracy as compared to transvaginal ultrasonography. Hysteroscopy was found to be highly accurate in diagnosing endometrial carcinoma (100%) and endometrial polyps (100%). However, both methods showed similar accuracy (97.5%) in diagnosis of proliferative endometrium and hyperplasia.Conclusions: Hysteroscopy is comparable to histopathology and superior to transvaginal sonography in the diagnosis of intrauterine causes for postmenopausal bleeding, it also offers the possibility of visualizing macroscopic or focal intra-uterine abnormalities.

scholarly journals Hysteroscopy in one hundred cases of postmenopausal uterine bleeding, in the detection of uterine cancer and atypical endometrial hyperplasia

2020 ◽  
Vol 9 (6) ◽  
pp. 2253
Author(s):  
Pratibha Devabhaktuni ◽  
Padmaja Allani ◽  
Suneetha Komatlapalli ◽  
Rekha Rani Ksheerasagara
Keyword(s):  
Endometrial Hyperplasia ◽  
Endometrial Thickness ◽  
Uterine Cancer ◽  
Endometrial Adenocarcinoma ◽  
Atypical Hyperplasia ◽  
Postmenopausal Bleeding ◽  
Uterine Carcinosarcoma ◽  
Benign Lesions ◽  
Operative Hysteroscopy ◽  
Vaginal Sonography

Background: Evaluation was done in 100 women presenting with postmenopausal bleeding, (PMB), to discuss the utility of hysteroscopy combined guided endometrial curettage in the diagnosis of uterine cancer and endometrial hyperplasia, and, treat benign lesions, like polyps, synechiae at the same sitting. At MGMH during the years, 2002 to 2006, there were 57 women, and at care, 40 women with PMB during 2011 to 2013, and three in a nursing home, Hyderabad, were investigated.Methods: Evaluation was done in 100 women presenting with PMB by hysteroscopy and curettage to diagnose the cause of PMB and benign lesions like polyps, synechiae were managed by operative hysteroscopy. Bettocchi 5 mm hysteroscope, monopolar instruments and glycine was used for excision of polyps.Results: In one hundred women with PMB, 19% had cancer. Endometrial adenocarcinoma in 14, endocervical carcinoma in 2, uterine carcinosarcoma in 3 cases. All 3 cases of uterine carcinosarcoma on hysteroscopy were large polyps measuring 5×5-6 cm size. Atypical hyperplasia endometrium in 7% and simple hyperplasia in 17%, was reported on histopathology, in cases with hyperplastic endometrium on hysteroscopy. Benign polyps in 41% were managed at the same sitting by operative hysteroscopy.Conclusions: Women with postmenopausal bleeding must have USG, trans vaginal sonography (TVS), endometrial thickness (ET) measurement, preferably endometrial echo complex (EEC). In women with PMB, the risk of uterine cancer would be 19%, i.e., 1 out of 5 women. Atypical hyperplasia in 7%. Hysteroscopy guided curettage, with histopathology, is the gold standard protocol in cases of PMB.

scholarly journals Role of transvaginal sonography in the detection of endometrial carcinoma

2014 ◽  
Vol 39 (2) ◽  
pp. 80-85
Author(s):  
MS Showkat ◽  
S Nabi ◽  
L Khondker ◽  
B Bhowmik ◽  
SN Tushar ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Predictive Value ◽  
Cross Sectional Study ◽  
Transvaginal Sonography ◽  
Histopathological Diagnosis ◽  
Cross Sectional ◽  
Menopausal Women ◽  
Post Menopausal ◽  
Sensitivity Specificity ◽  
Transabdominal Sonography

Transvagival sonography is superior to transabdominal sonography in most cases of pelvic pathology. Objective of this study is to evaluate the clinical usefulness of transvaginal ultrasonography (TVS) in pre, peri and post menopausal women suspected to have endometrial carcinoma. This cross sectional study was done with 40 patients who are clinically suspected having thickened endometrium. The study was carried out January 2007 to November 2008 for a period of two years. The patients having endometrial carcinoma diagnosed by TVS was correlated with histopathological diagnosis following collection of the report from the respective cases. Of total 40 cases, 2(5.0%) cases were endometrial carcinoma and 38(95.0%) were negative for endometrial carcinoma respectively in TVS findings. On the other hand 3(7.5%) cases were endometrial carcinoma and 37 (92.5%) cases were negative for endometrial carcinoma in histopathological findings. The validity of TVS in diagnosis of endometrial carcinoma were studied by calculating sensitivity, specificity, accuracy, positive predictive value and negative predictive value, which were 67 percent, 100 percent, 98 percent, 100 percent and 97 percent respectively. As the TVS findings of the present study correlated well with the histopathology findings and the validity test values were higher than observed by others, it can be concluded that TVS is sensitive and accurate modality in the evaluation of endometrial carcinoma. DOI: http://dx.doi.org/10.3329/bmrcb.v39i2.19647 Bangladesh Med Res Counc Bull 2013; 39: 80-85

scholarly journals Women with Abnormal Endometrial Pathology: Experienced at a Tertiary Care Hospital in Bangladesh

2013 ◽  
Vol 5 (1) ◽  
pp. 11-13
Author(s):  
Mst Syeeda Showkat ◽  
Lubna Khondker ◽  
Shahryar Nabi ◽  
Bishwajit Bhowmik
Keyword(s):  
Endometrial Hyperplasia ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Transvaginal Sonography ◽  
Common Disease ◽  
Care Hospital ◽  
Cross Sectional ◽  
Examination Result ◽  
Endometrial Pathology

Background: Transvaginal sonography is superior to transabdominal sonography in most cases of pelvic pathology. Objective: This study was undertaken to see the clinicalpathological characteristics of endometrial hyperplasia. Methodology: This cross sectional study was carried out from January 2007 to December 2008 for a period of two years. All suspected cases of endometrial hyperplasia were included for this study. Transvaginal sonography (TVS) performed and confirmation was done by histopathological examination. Result: A total number of 40 cases were enrolled for this study. The most common diagnosed endometrial pathology was endometrial hyperplasia which was 42.5% cases. Endometrial polyp was diagnosed in 32.5% cases. Endometrial carcinoma was in 7.5% patients and submucosal fibroid was in 10.0%. Conclusion: Endometrial hyperplasia is the most common disease among the women presented with endometrial pathology. DOI: http://dx.doi.org/10.3329/jssmc.v5i1.16198 J Shaheed Suhrawardy Med Coll, 2013;5(1):11-13

scholarly journals Diagnostic Accuracy of Lower Uterine Segment Scar Thickness ≤1.6mm in Prediction of Scar Dehiscence in patients

2021 ◽  
Vol 15 (10) ◽  
pp. 2682-2684
Author(s):  
Fiza Asif ◽  
Sobia Zafar ◽  
Tehmina Zafar ◽  
Tayyaba Majeed ◽  
Zahid Mahmood
Keyword(s):  
Cesarean Section ◽  
Diagnostic Accuracy ◽  
Gold Standard ◽  
Lower Uterine Segment ◽  
Transvaginal Sonography ◽  
Cross Sectional ◽  
Standard Material ◽  
Lower Segment Cesarean Section ◽  
Study Results ◽  
Uterine Scar

Background: Cesarean section uterine scar dehiscence (CSD) is a rare but notable complication of Lower segment cesarean section (LSCS) surgery. The cause for a uterine scar dehiscence is based on the etiology behind the uterine scar defect or any event that would predispose the cesarean scar to dehisce. Globally accepted option for assessing the CS scar is transvaginal ultrasonography of the non-pregnant uterus. Objective: To determine the diagnostic accuracy of lower uterine segment scar thickness≤1.6mm in the prediction of scar dehiscence in patients with previous one LSCS who are undergoing repeat LSCS after trial of labour taking intraoperative findings as gold standard. Material and methods: This cross sectional study was conducted in Services Hospital, Lahore for 6 months. The Non probability consecutive sampling technique was used to include women with previous one LSCS at 36-38 weeks were asked to get their TVS done for scar thickness. Women with scar thickness≤1.6mm and scar thickness>1.6mm were identified. Their intraoperative findings of scar dehiscence were confirmed. All the data was entered and analyzed on SPSS version 20. Results: The mean age of patients was 29.87±6.07 years. The emergency LSCS was done in 599(49.1%) patients and elective LSCS was done in 621(50.9%) patients. The sensitivity, specificity & diagnostic accuracy of TVS was 98.31%, 99.05% & 98.69% respectively. Conclusion: According to our study results the TVS for uterine scar is a very useful and effective tool in the prediction of scar dehiscence in patients with previous one LSCS taking intraoperative findings as gold standard. Keywords: Transvaginal sonography, TVS, Uterine, Scar, dehiscence, LSCS, Intraoperative

scholarly journals Neuroophthalmic Manifestations of Intracranial Tumours in Children

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Megha Kotecha ◽  
Sarang Gotecha ◽  
Ashish Chugh ◽  
Prashant Punia
Keyword(s):  
Brain Tumours ◽  
Motor Deficits ◽  
Histopathological Diagnosis ◽  
Older Children ◽  
Study Objective ◽  
Intracranial Tumours ◽  
Ocular Symptoms ◽  
Magnetic Resonance Imaging Mri ◽  
High Index Of Suspicion ◽  
Supratentorial Tumours

Background. All children between 0 and 16 years presenting with brain tumours confirmed by Magnetic Resonance Imaging (MRI) and treated surgically in our institute were included in this study. Objective. The aim of this study is to evaluate the neuroophthalmic and clinical characteristics of intracranial space occupying lesions in children. Methods. Neuroophthalmic manifestations along with location of the tumour by contrast-enhanced MRI, type of surgical intervention, and postoperative histopathological diagnosis were evaluated. Results. In pediatric brain tumours, male preponderance was seen and supratentorial location was more common in general, while in older children, infratentorial tumours were more common than supratentorial tumours. Headache, vomiting, and cerebellar signs were the commonest neurological features. Diminution of vision, diplopia, and strabismus were the commonest ophthalmic symptoms. Papilledema, ophthalmoparesis, and nystagmus were the most frequent ophthalmological signs. Neurological manifestations of seizures, altered sensorium and motor deficits were more frequently seen in supratentorial tumours, while cranial nerve involvement and ataxia were seen in infratentorial tumours. Ophthalmological manifestations including diplopia, strabismus, ophthalmoparesis, and nystagmus were more frequently seen in infratentorial tumours. Astrocytoma was the most frequent histopathological diagnosis followed by medulloblastoma. Conclusion. Diagnosis of pediatric intracranial tumours is complex and requires a multidisciplinary approach for prompt management. An ophthalmologist should have a high index of suspicion for brain tumours especially in patients presenting with common ocular symptoms like diminution of vision, diplopia, and strabismus without any neurological symptoms.

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