DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20221290

Correlation of ultrasound, hysteroscopic and endometrial histopathology findings in patients with post-menopausal bleeding

Shalini Mahapatra, Niranjan N. Chavan, Hera Mirza, Hitenrasing Rajput

Abstract


Background: To study endometrial changes by hysteroscopy and ultrasonography in women presenting with postmenopausal bleeding and correlate it with histopathological endometrial findings.

Methods: This was prospective observational study carried out in the Department of Obstetrics and Gynaecology at Lokmanya Tilak Municipal Medical College and General Hospital. The materials for the present study included patients diagnosed with postmenopausal bleeding visited to a Municipal Tertiary care centre and teaching institute in between January 2019 to June 2020. Total 51 eligible patients were evaluated.

Results: In this study, on TVS examination, maximum patients 45.10% were having endometrial thickness in between 6-12mm. On hysteroscopy, 35.29% of the patients were having atrophic endometrium which was the most common finding followed by Endometrial Hyperplasia in 29.41% patients. The most common histopathological finding was atrophic endometrium in 41.18% patients followed by endometrial hyperplasia in 23.53% patients. In TVS, lowest sensitivity and lowest specificity was in case of Atrophic Endometrium and highest sensitivity and highest specificity was in case of fibroid. In Hysteroscopy, lowest sensitivity was in case of carcinoma and lowest specificity was in case of Endometrial Hyperplasia and highest sensitivity was in case of fibroid and highest specificity was in case of fibroid and carcinoma.

Conclusions: Hence from this study, hysteroscopy is found to be an easy, safe, alternative and effective means to investigate postmenopausal women with a thickened endometrium found on TVS. Hysteroscopy guided biopsy in postmenopausal women with uterine bleeding decreases the risk of false negative histopathological report which is more commonly found in blind dilatation and curettage. This is also a useful method of visualizing the uterine cavity pathologies.

 


Keywords


Postmenopausal bleeding, Hysteroscopy, Endometrial carcinoma, Ultrasound, Histopathology

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References


WHO Scientific Group on Research on the Menopause in the 1990's. WHO Technical Report Series 866, Geneva, Switzerland, 1994. Available at: http://apps.who.int/iris/bitstream/10665/41526/1/WHO_TRS_670.pdf. Accessed on 01 March 2022.

Clinical Practice Guidelines on Menopause, International Menopause Society. Available at: https://www.imsociety.org/education/menopause-terminology/. Accessed on 01 March 2022.

Subramaniam S, Sushama, Rasika. Hospital based study of endometrial cancer survival. Ind Asian Pac J Can Prev. 2013;14(2):977-80.

Lidor A, Ismajovich B, Confino E, David MP. Histopathological findings in 226 women with post-menopausal uterine bleeding. Acta Obstet Gynecol Scand. 2006;(65):1:41-3.

Bani-Irshaid I, Al-Sumadi A. Histological findings in women with postmenopausal bleeding: Jordanian figures. East Mediterr Health J. 2011;17(7):582-6.

Lee WH1, Tan KH, Lee YW. The aetiology of postmenopausal bleeding--a study of 163 consecutive cases in Singapore. Singapore Med J. 2020;l36(2):164-8.

Astrup K, Olivarius Nde F. Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynecol Scand. 2004;83:203.

Rossouw JE, Anderson GL, Prentice RL. Risks and benefits of oestrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002;288:321.

Smith-Bindman R, Weiss E, Feldstein V. How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol. 2004;24:558.

Mirkin S, Archer DF, Taylor HS. Differential effects of menopausal therapies on the endometrium. Menopause. 2014;21:899.

Kothapally K, Bhashyakarla U. Postmenopausal bleeding: clinicopathologic study in a teaching hospital of Andhra Pradesh Int J Reprod Contracept Obstet Gynecol. 2013;2(3):344348.

Subramaniam B, Rasika S. Hospital based study of endometrial cancer survival. Ind Asian Pac J Can Prev. 2013;14(2):977-80.

Benign diseases of the reproductive track. Bereck Novak’s Gynecology. 14th edition; 2007. Lippincott Williams and Wilkins. Chapter 14;490.

Dunlop W, Ledger WL (Editor). Postmenopausal bleeding. In: Recent Advances in Obstetrics and Gynaecology. 24:245-58.

Purandare CN, Khadilkar SS. Menopause; current concepts. 1st edition. 2004.

Ind T. Management of post-menopausal bleeding. Prog Obstet Gynaecol. 10:361-77.

Kaur M, Singh R, Sharma M. Endovaginal sonographic evaluation of postmenopausal uterine bleeding. J Clin Diagn Res. 2010;4(2):2175-82.

Singh P, Dwivedi P, Mendiratta S. Correlation of Endometrial Thickness with the Histopathological Pattern of Endometrium in Postmenopausal Bleeding. J Obstet Gynecol India. 2016;66:42-6.

Maiti G, Lele P, Borse D. Fetal Comparison of transvaginal sonography with hysteroscopy and correlation with histopathological report in case of abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2018;7:710-4.

Munro MG. Southern California Permanente Medical Group’s Abnormal Uterine Bleeding Working Group. Investigation of women with postmenopausal uterine bleeding: clinical practice recommendations. Perm J Winter. 2014;18(1):55-70.

Tandulwadkar S, Deshmukh P, Lodha P, Agarwal B. Hysteroscopy in Postmenopausal Bleeding. J Gynecol End Surg. 2009;1(2):89-93.

Sagar S. Histopathological cases of uterus. J Obst Gynae. 2019;30:165.

Sarin AR, Singla P, Gupta SK. Endometrial changes in abnormal uterine bleedingAsia Oceania, J. Obst. Gyn. 1985;11:539.

Granberg S, Wikland M, Karlsson B, Norström A, Friberg LG. Endometrial thickness as measured by endovaginal ultrasonography for identifying endometrial abnormality. Am J Obstet Gynecol. 2020;164(1):47-52.

Gredmark T, Kvint S, Havel G, Mattsson LA. Histopathological findings in women with postmenopausal bleeding. BJOG. Int Obstet Gynaecol. 1995;102:133-6.

Goldstein SR, Nachtigall M, Snyder JR, Nachtigall L. Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding. Am J Obstet Gynecol. 1990;163(1):119-23.

Pacheco JC, Kempers RD. Etiology of postmenopausal bleeding. Obstet Gynecol. 1968;32:40-6.

Van den Bosch T, Ameye L, Van Schoubroeck D, Bourne T, Timmerman D. Intra-cavitary uterine pathology in women with abnormal uterine bleeding: a prospective study of 1220 women. Facts Views Vis Obgyn. 2015;7(1):17-24.

Jina R, Kar J, Sharma N, Srivatava R, Sharma SP, Jain RK et al. Transvaginal sonography of the endometrium in postmenopausal women The Journal of Obstetrics and Gynecology of India. 2002;52(2):99-101.

Ribeiro CT, Rosa-E-Silva JC, Silva-de-Sá MF, Rosa-E-Silva AC, Poli Neto OB, Candido Dos Reis FJ, et al. Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women. Sao Paulo Med J. 2007;125:338-42.

de Wit AC, Vleugels MP, de Kruif JH. Diagnostic hysteroscopy: a valuable diagnostic tool in the diagnosis of structural intra-cavital pathology and endometrial hyperplasia or carcinoma?. Six years of experience with non-clinical diagnostic hysteroscopy. Eur J Obstet Gynecol Reprod Biol. 2003;110(1):79-82.