Citation Information :
Acharya N, Gadge A, Phatak S. Comparative Study of Transvaginal Sonography and Hysteroscopy for the Detection of Endometrial Lesions in Women with Abnormal Uterine Bleeding in Perimenopausal Age Group. J South Asian Feder Obs Gynae 2018; 10 (3):155-160.
Aim: The aim of the study is to compare the diagnostic accuracy of transvaginal ultrasound and hysteroscopy correlated with histopathology in evaluation of endometrial lesions in perimenopausal women with abnormal uterine bleeding.
Settings and design: A cross-sectional study done in Department of Gynecology, from August 2015 to June 2017.
Materials and methods: A total of 100 perimenopausal women with abnormal uterine bleeding (AUB) were included in the age group 40 to 55 years. Transvaginal ultrasound (TVS), hysteroscopy and endometrial biopsy were performed on all patients. Findings were compared with histopathogical examination taken as gold standard.
Results: Menorrhagia was most common bleeding pattern seen in 44% cases. The TVS findings in correlation with HPE where fibroid and hyperplasia with polyp were 100% diagnosed while hyperplasia, polyp and normal findings were diagnosed 53.33%, 88.89% and 53.33% respectively. Hysteroscopy findings in correlation with HPE where fibroid, hyperplasia and hyperplasia with polyp were 100% diagnosed while polyp and normal findings were diagnosed 83.33%, 73.33% respectively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of TVS and hysteroscopy were 82.05%, 72.73%, 91.43%, 53.33%, 80% and 89.74%, 100%, 100%, 73.33%, 92% respectively.
Conclusion: We conclude that TVS is a good diagnostic initial modality for the diagnosis of endometrial lesions in AUB. But hysteroscopy should be done as a basic investigation even in cases where TVS is normal and endometrial biopsy should be taken where hysteroscopy shows normal findings.
Goldstein SR. Menorrhagia and abnormal bleeding before the menopause. Best Pract Res Clin Obstet Gynaecol 2004;18:59- 69.
Vilos GA, Lefebvre G, Graves GR. Guidelines for the management of abnormal uterine bleeding. J Obstet Gynaecol Can 2001;23:704-709.
Speroff L, Fritz MA. editor. Clinical gynecologic endocrinology and infertility. 7th ed. Philadelphia, London: Lippincott Williams & Wilkins, 2005: 628.
Lefebvre G, Vilos G, Allaire C, Jeffrey J. The management of uterine leiomyomas. Am J Obstet Gynecol 2003;128:1-10.
Telner DE, Jakubovicz D. Approach to diagnosis and management. Can Family Physic 2007;53:58–64.
Dubinsky TJ, Parvey HR, Maklad N. The role of transvaginal sonography and endometrial biopsy in the evaluation of peri and postmenopausal bleeding. Am J Roentgenol 1997;169(1): 145-149.
Breitkopf D, Frederickson R, Snyder R. Detection of benign endometrial masses by endometrial stripe measurement in premenopausal women. Obstet Gynecol 2004;104(1):120-125.
Hoffman BL. Abnormal uterine bleeding, benign general gynecology. In: Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG editors. Williams Gynecology. 1st ed. United States: McGraw-Hill Companies, 2008.
Desai K, Patole K, Kathaley M. Endometrial evaluation by histopathology in abnormal uterine bleeding in perimenopausal and postmenopausal patients. MVP Journal of Medical Sciences. 2014 Jul 1;1(2):75-79.
Mahapatra M, Mishra P. Clinicopathological evaluation of abnormal uterine bleeding. J Health Res Rev 2015;2:45- 49.
Joshi SK. Atypical uterine bleeding-Histopathological audit of endometrium A study of 638 cases. Al Ameen J Med Sci. 2013;6(1):21-28.
Khan S, Hameed Sadia, Umber A. Histopathological Pattern of Endometrium on Diagnostic D & C in patients with Abnormal Uterine Bleeding. Annals 2011;17(2):166-170.
Bhosle A, Fonseca M. Evaluation and histopathological correlation of abnormal uterine bleeding in perimenopausal women. Bombay Hospital J. 2010;52(1):69-72.
Rifat AG, Mahmoud MM. Endometrial Histopathological changes in women with Abnormal Uterine bleeding in Kirkuk City, a Clinicopathological Study. Medical Journal of Babylon. 2013;10(3):567-582.
Sharma J, Tiwari S. Hysteroscopy in Abnormal Uterine Bleeding vs Ultrasonography and Histopathology Report in Perimenopausal and Postmenopausal Women. women. 2016 Jul 1;55(203)
Pyari JS, Rekha S, Srivastava PK, Goel M, Pandey M. A comparative diagnostic evaluation of hysteroscopy, transvaginal ultrasonography and histopathological examination in cases of abnormal uterine bleeding. J Obstet Gynecol India. 2006 May;56(3):240-243.
Pillai SS; Sonographic and histopathological correlation evaluation of endometrium in perimenopausal women with abnormal uterine bleeding; Int J Reprod Contracept Obstet Gynecol. 2014 Dec; 3(1):113-117
Deckardt R, Lueken RP, Gallinat A, Moller CP, Busche D, Nugent W, et al. Comparison of transvaginal ultrasound, hysteroscopy, and dilatation and curettage in diagnosis of abnormal vaginal bleeding and intrauterine pathology in perimenopausal and postmenopausal women. J Am Assoc Gynecol Laparoscop 2002;9:277-282.
El-khayat W, Sleet ME, Mahdi EY. Comparative study of transvaginal sonography and hysteroscopy for the detection of pathological endometrial lesions in women with perimenopausal bleeding. Middle East Fertil Soc J. 2011;16:77-82
Vitner D, Filmer S, Goldstein I, Khatib N, Weiner Z. A comparison between ultrasonography and hysteroscopy in the diagnosis of uterine pathology. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2013 Nov 30;171(1):143- 145.
Ryu JA, Kim B, Lee J, Kim S, Lee SH. Comparison of transvaginal ultrasonography with hysterosonography as a screening method in patients with abnormal uterine bleeding. Korean J Radiol 2004;5:39-46.
Tandulwadkar S, Lodha P, Agarwal B, Deshmukh P, Naik S. Hysteroscopy-a mode of screening women with postmenopausal bleeding: our experience. Journal of South Asian Federation of Obstetrics and Gynecology. 2011 Apr 4;3(1): 10-13.
Vasanthi V, Prabha G, Indira N, Chinnappa K. Comparison of imaging modalities in abnormal uterine bleeding: correlation with hysteroscopic guided biopsy. International Journal of Medical and Health Sciences. 2016; 5(2):99-103.
Chaudhari KR, Sathe P. Role of diagnostic hysteroscopy in evaluation of abnormal uterine bleeding and its histopathological correlation. Int J Reprod Contracept Obstet Gynecol 2014;3:666-670.