Title: Role of Transvaginal Ultrasound and Endometrial Biopsy in Evaluating Abnormal Uterine Bleeding in Reproductive and Perimenopausal Age Group
Authors: Dr Niharika. S, Dr Nyma Sultana
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.142
Abstract
This was a prospective study conducted at OBG department Mamata Medical College, Khammam .This study was carried out with 100 women in the reproductive and perimenopausal age group who presented with AUB during the period from Jan 2016 to Jan 2017. All the patients were subjected to Transvaginal Ultra Sound and dilatation and curettage. 45% of the patients in the study are between 41-46 yrs. 55% of patients presented with menorrhagia. 64% of patients had anaemia, 23 %diabetes, and 5% thyroid disorders were associated risk factors. The mean endometrial thickness was 10.1mm and majority of cases 50% had endometrial thickness16mm. Transvaginal Ultra Sound finding were reported as normal in 21%, fibroid in 38%, polyp in 9%, adenomyosis in 9%, hyperplasia in 9% and 14% were atrophic, bulky uterus. Fibroid was a common finding in our study. Histopathology reports of D&C showed the 63% were proliferative endometrium, 21% were secretory endometrium, 8% were hyperplasia and 8% were others such as atrophic endometrium. In our study Transvaginal Ultra Sound showed 100% sensitive and specific for the diagnosis of polyp. In our study when the endometrial thickness more than16 mm, the pathology of the endometrium was simple, complex hyperplasia. No carcinoma was diagnosed in the study. 84% of perimenopausal women underwent hysterectomy the indication being severe menorrhagia and the HPE findings correlates with the Transvaginal Ultra Sound finding. This study proves that Transvaginal Ultrasound, as a diagnostic tool is more sensitive than specific when compared to the histopathology findings. Both the methods of evaluating the endometrium namely the transvaginal ultrasound and endometrial biopsy are complementary to each other,therefore both should be used in evaluation of AUB.
Keywords: Abnormal uterine bleeding, Transvaginal ultra sound, dilatation and curettage, Biopsy, Diagnosis.
References
- Dubinsky T, Abu Gazzehy, Stroeh Lein K, Role of TVS and endometrial biopsy in the evaluation of dysfunctional uterinebleeding in peri and post menopausal women. in measurement ofendometrial thickness in post menopausal women: Br. J.obstel., gynaecol,98;370,1999.
- Rishad Hafiz, Mohammad Ali, Mansoor ahmad Fibroid as a causative factor in menorrhagia and its management, Pakistan. J.Med Res,2003 Vol.42 No 3, 42-48.
- Minagawa Y ; Sato S ito M, Onohara Y. Nakamotos, Kigawa . Transvaginal ultrasonography and endometrial biopsy as a diagnostic schema for endometrial cancer and hyperplasia. Gynecol obslet Invest 2005 ; 59 (3) : 149-54.
- Towbin, March et al. Office hysteroscopy versus transvaginal ultrasonography in post menopausal bleeding. Am J Obstet Gynecol 1996;174:1678-82.)
- N. Nasri, J.H. Shepherd, M.E. Setchell, D.G. Lowe & T.Chard: The Role of vaginal scan. Lewin A, Gabis L, Ushakov F, Anteby SA, Endometrial measurement by transvaginal sonography in post menopausal bleeding, Harefuah 1996 May 15; 130 (10) ; 662-8.
- Loverro G, Bettocchi S, Cormio G, Nicoloardiv, Transvaginal sonography and hysteroscopy in post menopausal uterine bleeding. Marturitas 1999 Oct 24 ; 33(2) : 139-44.
- Kufahl J, Pedersen J, Sindberg Eriksen P, Helkjaer PE, Transvaginal ultrasound, endometrial cytology by Gynoscann and histology obtained by uterine explora curette compared to the histology Acta obstet Gynaeacol Scand 1997 Sep; 76(8 : 790-6.
- Epsterin E, Valentin L. Rebleeding and endometrial growth in women with PMB and endometrial thickness less than 5mm managed by dilatation and curettage or ultrasound follow-up: a randomized controlled study. Ultrasound obstet Gynecol 2001 Nov 18(5), 499-504.
- Epstein E, Skoog L, Valentin L, Comparison of Endorette and D & C for sampling of the endometrium in women with post menopausal bleeding. Acta Obstet Gynecol Scand, 2001 Oct ; 80(10) 959-64.
- Tong Song T, Pongnarisom C, Mahanuphap, Use of vaginal sonogrpahic measurements of endometrial thickness in the identification of abnormal endometrium in Peri menopausal and Postmenopausal bleeding. J Clin Ultrasound 1994 Oct ; 22 (8) : 479-82.
- Minagawa Y; Sato S ito M, Onohara Y. Nakamotos, Kigawa. Transvaginal ultrasonography and endometrial biopsy as a diagnostic schema for endometrial cancer and hyperplasia. Gynecol obslet Invest 2005 ; 59 (3) : 149-54.
- Larson DM, Johnson KK, Broste SK et al, comparison of D & C and office endometrial biopsy in predicting final HP grade in endometrial cancer. Obstet Gynecol 1995; 86:38.