Etiology distribution of abnormal uterine bleeding according to FIGO classification system: A combined study of ultrasound and histopathology

Abstract

Aim To classify the FIGO's PALM‐COEIN etiology for abnormal uterine bleeding (AUB) patients according to the ultrasound and histopathology and to evaluate the etiology prevalence distribution for AUB patients. Methods A total of 1065 women with AUB in the Second Hospital of Shandong University between January 2019 and March 2021. The intrauterine histopathological and ultrasound results were reviewed retrospectively.PALM‐COEIN etiology classification was performed according to histopathology and ultrasound. The classification system was stratified into nine basic categories: Polyp (AUB‐P), adenomyosis (AUB‐A), leiomyoma (AUB‐L), malignancy and hyperplasia (AUB‐M), coagulopathy (AUB‐C), ovulatory disorders (AUB‐O), endometrium (AUB‐E), Iatrogenic(AUB‐I), and not classified (AUB‐N). The number of cases and composition ratio were also calculated. Results According to the FIGO's classification system, the PALM group (656,61.60%), which were defined as structural entities that can be measured visually with ultrasound and/or histopathology. 176 (16.53%) patients were classified as AUB‐P,102 (9.58%) patients were classified as AUB‐A, 487(45.73%) patients were classified as AUB‐L, 31 (2.91%) patients were classified as AUB‐M. The COEIN group (409,38.40%), which were defined as nonstructural entities that cannot be measured by ultrasound and/or histopathology. Nobody were classified as AUB‐C in our group, and 383 (35.96%) patients were classified as AUB‐O, 4 (0.38%) patients were classified as AUB‐E,14 (1.31%) patients were classified as AUB‐I,8 (0.75%) patients were classified as AUB‐N. Conclusion In our study, AUB‐L was the most common cause, followed by AUB‐O, AUB‐P, AUB‐A, AUB‐M, AUB‐I, AUB‐N, and AUB‐E.PALM‐COEIN etiology classification system played an important role in the epidemic and management standardization of AUB patients, provided an effective communication between physicians and researchers also. Ultrasonography was the preferred examination for AUB patients, especially with structural abnormalities.

The role of FIGO-PALM pathologies in heavy menstrual bleeding resistant to levonorgestrel-releasing intrauterine system (Mirena®) treatment

“…This study, for in heavy menstrual bleeding patients who underwent LNG-IUD, when we classified the ultrasound findings according to the etiology of PALM-COEIN, the most leiomyoma was 50% and the least adenomyosis and polyp (for both 16.6%). Ni et al [21], in which they classified the etiology of PALM-COEIN for heavy menstrual bleeding according to ultrasound and histopathology, the findings revealed as leiomyoma (45.7%), polyp (16.5%), adenomyosis (9.6%) and malignant lesions (2.9%), respectively [21].…”

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.…”

Adenomyosis and Abnormal Uterine Bleeding: Review of the Evidence

“…The most common type was the group with fibroids (AUB-L, 47.4%) whilst adenomyosis (AUB-A) was present in 14.1%. Ni et al [35] classified 1065 women with AUB based on the FIGO PALM-COEIN classification using ultrasound and histopathology criteria. In this group 102 (9.6%) women were identified with adenomyosis, mostly (81.4%) diffuse disease.…”