A comparative diagnostic evaluation of hysteroscopy, transvaginal ultrasonography and histopathological examination in 50 cases of abnormal uterine bleeding
Authors: Sujatha Audimulapu, M. Sudeepti
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Background: AUB is a common gynecological complaint and it may involve females at any age group. 33% of women referred to gynaecology clinics have AUB and the figure rises to 69% in premenopausal and postmenopausal women.
Aim: To compare the diagnostic efficacy of transvaginal ultrasonography and hysteroscopy in detecting uterine abnormalities in abnormal uterine bleeding by correlating the results with histopathological examination.
Materials and methods: This was a prospective and comparative study which was conducted in Modern Government Maternity Hospital, Petlaburz, Osmania Medical College, and Hyderabad and it was conducted from November 2013 to July 2015. This study had 50 patients with AUB. Inclusion criteria: Women with abnormal uterine bleeding such as Heavy menstrual bleeding, intermenstrual bleeding, irregular and heavy bleeding, Regular, frequent and Heavy bleeding , postmenopausal bleeding , continuous bleeding , related to uterine causes. Exclusion criteria: Pelvic infection, Pregnancy, drug intake that can lead to vaginal bleeding (anticoagulants, hormonal replacement therapy, hormonal contraceptives), vaginal, vulval or cervical causes of bleeding. Informed consent was taken for all the patients, subjected to the study.
Results: In the study, diagnostic hysteroscopy, transvaginal ultrasonography and hysteroscopy were done in 50 cases of abnormal uterine bleeding. Mean age of the patients enrolled in the study was 44.5±5.36 years. Most common bleeding pattern observed was Heavy flow with regular cycles (Menorrhagia) which was observed in 42% of the patients followed by Heavy flow with irregular cycles (Menometrorrhagia) which was observed in 26% of the patients in the study. With respect to parity of subjects, maximum incidence of abnormal uterine bleeding was seen in the parity of 2 (36%) followed by parity 3 (32%). Majority of patients came with 1-6 months duration of bleeding of AUB. Most common histopathology finding is Proliferative endometrium. Out of 50 cases, 38 cases (76%) of Hysteroscopy findings correlated with Histopathology and discrepancy in findings was noted in 12 cases (24%). In 26 cases (52%), TVS findings correlated with histopathology findings, and the results differed in 24 patients (48%). Sensitivity and specificity for Transvaginal ultrasonography is 62.8% and 86.6% in comparison with Sensitivity and Specificity of Hysteroscopy which is 74.3 % and 93.3 % respectively. Positive predictive value is 96.3 % and Negative Predictive value is 60.8% for hysteroscopy. Whereas, for Transvaginal ultrasonography, Positive predictive value is 91.6% and Negative Predictive Value is 50%. According to these findings, Hysteroscopy is superior to transvaginal ultrasonography in evaluating abnormal uterine bleeding because of higher sensitivity, specificity, positive predictive value, negative predictive value. Transvaginal ultrasonography is non-invasive, relatively cheap, causes minimal discomfort to the patient and can be used as the initial modality in patients with abnormal uterine bleeding. However, it has inferior diagnostic value when compared to hysteroscopy.
Conclusion: In conclusion, although Transvaginal ultrasonography represents a practical approach for the initial evaluation of uterine pathologies, a hysteroscopy examination would be necessary in most of the suspicious cases. Hysteroscopy remains the best option for the assessment of AUB owing to its diagnostic performance when compared to Transvaginal ultrasonography. It allows direct visualization of the cavity and also sampling for histopathological examination.