Accuracy of Transvaginal Ultrasonography Compared to Endometrial Biopsy for the Etiological Diagnosis of Abnormal Perimenopausal Bleeding

Abstract

Background and aimsPerimenopause is marked by clinical manifestations which disturb everyday life and which may also hide a pathomorphological, more precisely endometrial, substrate. An accurate early diagnosis established by accessible, non-invasive methods is very important for the therapeutic management.MethodThe study included 103 patients aged between 41.5–55.11 years, divided into 3 age groups: 40–44 years (n=10), 45–49 years (n=54) and ≥50 years (n=39).ResultsCertain risk factors of endometrial neoplasm or premalignant conditions were evidenced, their accurate identification being useful in limiting the number of patients with abnormal uterine bleeding (AUB) submitted to diagnostic screening. The most common cause of AUB in our study was fibroma, followed by functional causes.ConclusionsTransvaginal ultrasound (TVUS) represents a minimally invasive method for the screening of perimenopausal patients with AUB, especially to rule out endometrial adenocarcinoma (EAC). TVUS sensitivity was higher than clinical diagnosis in case of leiomioma, polypi and EAC. TVUS was more accurate in the diagnosis of EAC, polypi and leiomioma.

Correlation between ultrasonographic and histopathological findings of hysterectomy specimen in patients with abnormal uterine bleeding

“…The study result is consistent with many other studies conducted across the globe, where fibroid uterus was the common condition associated with abnormal uterine bleeding. 12,20,21,[27][28][29] Unless uterine polyp, uterine fibroid develops during the reproductive age group, which would have contributed to the above finding, since majority of patients in this study were in the reproductive age group. Adenomyosis was the next common condition diagnosed by ultrasound which is also comparable with other studies.…”

“…12 The results were consistent with numerous studies, where the ultrasound was as good as histopathology in the diagnosis of uterine fibroid in patients with abnormal uterine bleeding. 21,27,[30][31][32] However a study conducted by Hunter et al showed a sensitivity of 75% for USG in diagnosing uterine fibroid, even though it showed a specificity of 90%. 33 Similarly, a study conducted by Erdem et al showed a specificity of 100%.…”

“…12 Similarly, Nicula et al reported a sensitivity of 8% for diagnosing adenomyosis. 27 Hence, USG has a limitation in tissue characterization in diagnosis of adenomyosis. The agreement (kappa) between USG and histopathology was 0.623.…”

Analysis of the results of invasive diagnostic procedures in patients referred to gynecologic department due to abnormal uterine bleeding

“…Perimenopause is the time of women's life of natural shift from regular bleeding to anovulatory cycles with irregular and frequently excessive menstruation and eventually permanent infertility [ 5 ]. It usually starts 2-8 years before menopause and ends one year after [ 6 ]. Endometrial biopsy preceded by taking medical history, clinical examination and transvaginal ultrasound is a routine procedure in gynecological practice.…”

Role of Uterine Artery Doppler Indices in Patients with Perimenopausal Bleeding for Diagnosis of Endometrial Pathologies: A Prospective Study

“…Ultrasound [US] could play a role in the exclusion of organic lesions for AUB. This is important because AUB is the main etiology for hysterectomy and represents two-thirds of all hysterectomies [4] .…”