Use of diagnostic hysteroscopy in abnormal uterine bleeding in perimenopausal age group and its clinicopathological co-relation with ultrasound and histopathology findings: experience in a tertiary care institute
Keywords:
AUB, Hysterosocopy, Ultrasonography, Perimenopausal age groupAbstract
Background: Abnormal Uterine Bleeding (AUB) refers to bleeding that is excessive or occurs outside of normal cyclic menstruation. It accounts for two-thirds of all hysterectomies worldwide. Evaluation of the endometrium as a cause of AUB is done mainly in three modes i.e. by Imaging of endometrium by transvaginal/transabdominal ultrasound, visual assessment by hysteroscopy and cellular assessment by microscopic evaluation of endometrial samples.
Methods: Ours is a retrospective observational study of all diagnostic hysteroscopies performed for AUB in 40-45 year age group at Cama and Albless hospital, Mumbai between April 2012 and January 2015. We studied 66 cases of conventional diagnostic hysteroscopy at our institute to establish correlation of hysteroscopy findings with other diagnostic tools i.e. ultrasound and histopathological findings.
Results: On ultrasound 65.2% of the endometrial pathologies leading to AUB were due to endometrial hyperplasia with polyp accounting for 4.5%. 43.9% of the total patients were having fibroid as associated pathology on ultrasound. On hysteroscopy more number of cases of polyp were diagnosed (21.2%) as compared to ultrasound (4.5%). On histopathological appearance we found simple hyperplasia in 4.5% of cases and simple hyperplasia with atypia in 1.5% all of cases i.e. 6% total cases of hyperplasia. These are potentially carcinogenic patients. 47% of cases had endometrium in proliferative phase which is the commonest pathological finding on histopathological examination.
Conclusions: The relatively poor sensitivity of both endometrial biopsy and ultrasound in the detection of intrauterine focal pathology encourage us to propose that Hysteroscopy be utilized as a first line investigation in AUB.
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