A clinicopathological correlation of international federation of gynecology and obstetrics's PALM–COEIN classification of abnormal uterine bleeding: Indian scenario

Abstract

Background:Abnormal uterine bleeding (AUB) is a common problem affecting the women of reproductive age group and may also have a significant impact on their physical, social, and emotional aspects directly affecting their quality of life. The International Federation of Gynecology and Obstetrics (FIGO) devised a universally acceptable system of nomenclature and classification, namely PALM–COEIN classification of AUB in the year 2011. The objective of the present study was to analyze the structural (PALM) and functional (COEIN) component of FIGO system in the Indian scenario.Materials and Methods:Three hundred patients with complaints of AUB were taken. A clinical diagnosis according to PALM–COEIN system was made after thorough history and clinical examination. Additional investigations if required were done, and endometrial sampling or hysterectomy was done whichever indicated. A histological diagnosis was made, and each case was allocated a category according to PALM–COEIN classification. A clinicopathological correlation was done in the hysterectomy cases for structural causes (PALM).Results:Leiomyoma (30%) was the most common cause of AUB closely followed by adenomyosis (29.66%) overall. The clinicopathological correlation in hysterectomy cases was good with concordance rate of 85.03%. The concordance between clinical and pathological diagnoses for AUB-L, AUB-A, AUB-M, and AUB-A, L was statistically significant with P < 05 in positive cases. However, additional finding of adenomyosis was diagnosed in 48.2% of the cases apart from primary clinical diagnosis.Conclusion:A good clinicopathological correlation was seen in the cases when classified according to PALM–COEIN classification. The system also provides for consideration of multiple etiologies contributing toward AUB both clinically and histopathologically. However, histopathology remains the cornerstone in establishing the accurate diagnosis as the cases without specific symptoms can be missed clinically.

Clinicopathological Correlation of Non Oncological Hysterectomies at a Tertiary Healthcare Centre

“…Overall histopathology detected more polyps but the difference was not statistically significant. Our findings were similar to other such studies [12,13].…”

“…As compared to clinical diagnosis, histopathological examination detected structural abnormalities in more cases (529 vs 570 out of 702 cases) which was statistically significant too. Similar studies analysing clinicopathological correlation found histopathology detecting more structural pathologies than clinically suspected 13]. This was majorly due to additional histological detection of adenomyosis, coexistent dual structural pathologies like missed leiomyomas, polyps and premalignant cervical lesions.…”

Abnormal uterine bleeding in women of reproductive age: PALM-COEIN causes

“…Most of the scientists prefer the new classification of causes of AUB (PALM-COEIN) which takes into account the etiological factor 8,9,10…”

National survey of abnormal uterine bleeding according to the FIGO classification in Japan

“…Since the revision of the FIGO classification of AUB in 2018, reports on the incidence of each causative disease in PALM-COEIN 1,8,9,[12][13][14] and the relationship with ultrasound findings and pathology results in PALM-COEIN have mainly been reported using system 2. [15][16][17][18] In addition, some reviews explored biomarkers that may be useful in the diagnosis of AUB for each causative disease of AUB, 19 and most of the reports have discussed how to accurately diagnose the causative disease of AUB using PALM-COEIN. However, to the best of our knowledge, there have been no reports on the symptoms of AUB using system 1 or on the relationship between system 1 and system 2.…”