The New Indian Journal of OBGYN. Epub Ahead of Print
Comparative assessment of histopathology of the endometrium with transvaginal sonography, color doppler, and hysteroscopy in perimenopausal bleeding
Medhavi Sharma, Vinod Choudhary
ABSTRACT
Background: Abnormal uterine bleeding (AUB) is a common gynecological presentation in outpatient clinic, but is often complex and difficult to diagnose. Objectives: The present study was undertaken to compare the diagnostic efficacy of trans-vaginal sonography (TVS), color doppler, and hysteroscopy with histopathology of endometrium in perimenopuasal bleeding cases. Method: 105 patients with AUB in the perimenopuasal and post-menopausal age group (40-73) were underwent USG-TVS and color doppler, and followed by dilatation and curettage and endometrium was sent for histopathological examination. Correlation of ultrasonographic & color doppler findings with histopathology finding was done. Results: 53.33% patients presented with perimenopausal bleeding and 46.66% postmenopausal bleeding. According to USG examination, maximum patients (62.5%) had endometrial thickness <12mm in perimenopausal group while in postmenopausal group only 10(20.4%) had <5mm and >5mm in 79.6%. On color doppler examination, 10(12.04%) patients were having lower RI compare to normal range (<0.3), of which 3 were in perimenopausal and 7 in postmenopausal age group. On hysteroscopy examination, endometrium was hyperplastic in 12 (11.42%), irregular growth 7 (6.66%), unhealthy cheesy 2(1.90%), cystic hyperplasia 1(0.95%). On HPR examination, simple hyperplasia was found in 51(48.57%) patients followed by atrophied 16(15.23%), endometrial carcinoma 8(7.61%), cystic mass 7(6.66%) and complex hyperplasia with (3.81%) and without atypia (3.81%). The prediction of endometrial carcinoma by TVS, color doppler showed sensitivity 80%, specificity 97.2%, positive predictive value 80% and negative predictive value 100%. Conclusion: Color doppler USG was as effective as histopathology examination in diagnosis of endometrial carcinoma. Thus we can avoid endometrial biopsy for diagnosis of endometrial malignancy if USG findings were normal.