Hysteroscopy, Transvaginal Ultrasound and Histopathology in Evaluation of Abnormal Uterine Bleeding: Which is Best?
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- Category: Vol. 84, June 2016
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Hysteroscopy, Transvaginal Ultrasound and Histopathology in Evaluation of Abnormal Uterine Bleeding: Which is Best?, AHMED L. ABU EL NASR, WALID S. EL SHERBINY, TAMER F. TAHA, SAMEH H. SALAMA and AHMED A. ABBAS
Abstract
Background/Aim: Abnormal uterine bleeding in the pre-& postmenopausal women is the most common cause for gynecological referrals. It accounts for up to 33% of patients attending outpatient gynecology outpatient clinics. The pop-ularity of hysteroscopy has been enhanced because it is a simple technique that can be performed in the office. Its specificity and positive predictive value of hysteroscopy is higher than traditional D&C. Hysteroscopy has the advantage of diagnosing focal lesions, particularly pedunculated struc-tures, which are frequently missed by endometrial biopsy or D&C. The present study aimed to compare the efficacy and the acceptability of transvaginal sonography (TVS), hysteros-copy and endometrial biopsy in diagnosis of the various causes of pre- and post-menopausal bleeding.
Material and Methods: This study included 50 premeno-pausal and postmenopausal patients complaining of abnormal uterine bleeding. All of them were subjected to TVS, hyst-eroscopy and D&C; the results were correlated to the histo-pathological picture of the endometrium in order to obtain appropriate diagnosis of endometrial lesions.
Results: Hysteroscopy was the best tool in detecting endometrial polyp having sensitivity, specificity, PPV and NPV of 100%, 95.8%, 94.7% and 100%, respectively with total accuracy of 97.6%. For submucus myoma hysteroscopy had an accuracy of 100% for all cases diagnosed. For En-dometrial hyperplasia hysteroscopy had sensitivity, specificity, PPV and NPV of 90%, 96,8%, 90% and 96.8%, respectively with total accuracy 93.6%. For atrophic endometrium hyst-eroscopy had 66%, 100%, 100% and 97.5%, respectively with total accuracy of 90.8%. For endometrial carcinoma Hysteros-copy had 50%, 97.5%, 50% and 97.5% with total accuracy of 73.7%.
Conclusion: Hysteroscopy could be considered as a gold standard in evaluation of uterine cavity in comparison to TVS & D&C especially in diagnosing endometrial polyps and submucous myoma. D&C and histopathological examination have better accuracy than either hysteroscopy or TVS in diagnosis of hyperplasia and cancer. D&C confirms the diagnosis but can miss focal endometrial lesions.