Correlation of clinical and ultrasonographic features with histopathology in post-menopausal bleeding

Authors

  • Meenakshi Vempalli Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
  • Lopamudra B. John Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
  • G. Chandana Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20202715

Keywords:

Endometrial thickness, Postmenopausal bleeding, Ultrasonography

Abstract

Background: Postmenopausal bleeding is generally regarded as an ominous alarm of genital pathologies which requires a thorough evaluation clinically and pathologically to exclude carcinoma as the cause and ensure a benign pathology. This study aims at finding out whether clinical diagnosis and ultrasonographic features can be reliable parameters for the diagnosis of causes and whether the findings correspond with histopathology reports.

Methods: This observational study was conducted in a tertiary care centre in Pondicherry between January 2018 to August 2019. 114 women were enrolled for whom detailed history taking and clinical examination was done. All the patients were subjected to transvaginal ultrasonography. Patients with clinically visible lesions on cervix and vulva were subjected to biopsy and the rest underwent fractional curettage and the sample was sent for histopathological examination. Finally, histopathology report was compared with clinical and ultrasonographic findings.

Results: With endometrial thickness cut off of 4 mm, the sensitivity, specificity, positive predictive value and negative predictive value in predicting malignancy by ultrasonography were 100%, 12.3%, 4.5% and 100%. Histopathology showed atrophic endometrium (43.8%), endometrial hyperplasia (8%), endometrial polyp (7.9%) and endometrial carcinoma (3%). Clinical and ultrasonographic findings did not show any statistical correlation with histopathology.

Conclusions: Authors conclude that clinical findings and ultrasonographic features do not correlate with histopathology in cases of postmenopausal bleeding for which atrophic endometrium was the commonest etiology. However, ultrasound should be done routinely before endometrial sampling as the sensitivity for predicting malignancy was 100% for endometrial thickness cut off of 4 mm.

References

Olshansky SJ, Carnes BA, Cassel CK. The aging of the human species. Sci Am. 1993;268(4):46-52.

Astrup K, Olivarius N de F. Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynecol Scand. 2004;83(2):203-7.

Moodley M, Roberts C. Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection. J Obstet Gynaecol. 2004;24(7):736-41.

Yeole B. Trends in cancer incidence in female breast, cervix uteri, corpus uteri, and ovary in India. Asian Pac J Cancer Prev. 2007;9:119-22.

Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol. 1983;15(1):10-7.

Wong SF, Luk KL, Wong AY, Tang LC. Findings in women with postmenopausal bleeding investigated with hysteroscopy. J Inst Obstet Gynaecol. 2001;21(4):392-5.

Jadoon S, Khan SM, Qadir M, Bibi N. postmenopausal bleeding - a strong indicator of endometrial carcinoma. Pak Armed Forces Med J. 2019;69(2):368-72.

Escoffery CT, Blake GO, Sargeant LA. Histopathological findings in women with postmenopausal bleeding in Jamaica. West Indian Med J. 2002;51(4):232-5.

Kant RH, Iqbal A, Rather SY, Sharma P. Postmenopausal bleeding, endometrial curretage, endometrial hyperplasia, endo-metrial carcinoma, atrophic endometrium. significance Clin Histopathol Eval. 2015;42(4):7371-80.

Fatima SS, Naib JM, Sharafat Z, Mazhar T. Postmenopausal bleeding- an alarming symptom of endometrial carcinoma. J Med Sci. 2014;22(4):166- 70.

Burbos N, Musonda P, Giarenis I, Shiner AM, Giamougiannis P, Morris E, et al. Age-related differential diagnosis of vaginal bleeding in postmenopausal women: a series of 3047 symptomatic postmenopausal women. Menopause Int. 2010;16(1):5-8.

Narayanan V, Nair R. Evaluation of Endometrium in Postmenopausal bleeding women. Obs Gyne Rev J. 2016;2:3.

Fatima SS, Naib JM, Sharafat Z, Mazhar T. Postmenopausal bleeding- an alarming symptom of endometrial carcinoma. J Med Sci. 2014;22(4):166- 70.

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

Gerber B, Krause A, Kuelz T, Quasmeh A, Reimer T, Friese K. Rating of transvaginal sonography in the evaluation of postmenopausal bleeding. Zentralbl Gynakol. 1999;121(3):143-8.

Gull B, Karlsson B, Milsom I, Granberg S. Factors associated with endometrial thickness and uterine size in a random sample of postmenopausal women. Am J Obstet Gynecol. 2001;185(2):386-91.

Karlsson B, Granberg S, Wikland M, Ylöstalo P, Torvid K, Marsal K, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding-a nordic multicenter study. Am J Obstet Gynecol. 1995;172(5):1488-94.

Lewin A, Gabis L, Ushakov F, Anteby SA. Endometrial measurement by transvaginal sonography in postmenopausal bleeding. Harefuah. 1996;130(10):662-8.

Ferrazzi E, Torri V, Trio D, Zannoni E, Filiberto S, Dordoni D. Sonographic endometrial thickness: a useful test to predict atrophy in patients with postmenopausal bleeding. An Italian multicenter study. J Int Soc Ultrasound Obstet Gynecol. 1996;7(5):315-21.

Conoscenti G, Meir YJ, Fischer-Tamaro L, Maieron A, Natale R, D’Ottavio G, et al. Endometrial assessment by transvaginal sonography and histological findings after D and C in women with postmenopausal bleeding. J Int Soc Ultrasound Obstet Gynecol. 1995;6(2):108-15.

Phillip H, Dacosta V, Fletcher H, Kulkarni S, Reid M. Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Afro-Caribbean Jamaican women with postmenopausal bleeding. J Inst Obstet Gynaecol. 2004;24(5):568-72.

Gredmark T, Kvint S, Havel G, Mattsson LÅ. Histopathological findings in women with postmenopausal bleeding. Int J Obstet Gynaecol. 1995;102(2):133-6.

Lee WH, Tan KH, Lee YW. The aetiology of postmenopausal bleeding–a study of 163 consecutive cases in Singapore. Singapore Med J. 1995;36(2):164-8.

Dangal G. A study of endometrium of patients with abnormal uterine bleeding at Chitwan Valley. Kathmandu Univ Med J. 2002;1:110-2.

Caspi E, Perpinial S, Reif A. Incidence of malignancy in Jewish women with postmenopausal bleeding. Isr J Med Sci. 1977;13(3):299-304.

Bani-Irshaid I, Al-Sumadi A. Histological findings in women with postmenopausal bleeding: Jordanian figures. Eastern Mediterranean Health J. 2011;17(7):582-62.

Dawood NS, Peter K, Ibrar F, Dawood A. Postmenopausal bleeding: causes and risk of genital tract malignancy. J Ayub Med Coll Abbottabad. 2010;22(2):117-20.

Van Doorn LC, Dijkhuizen FPHLJ, Kruitwagen RFMP, Heintz APM, Kooi GS, Mol BWJ, et al. Accuracy of transvaginal ultrasonography in diabetic or obese women with postmenopausal bleeding. Obstet Gynecol. 2004;104(3):571-8.

Khan S, Hameed S, Umber A. Histopathological pattern of endometrium on diagnostic D and C in patients with abnormal uterine bleeding. Ann. 2011;17(2):166-70.

Choo YC, Mak KC, Hsu C, Wong TS, Ma HK. Postmenopausal uterine bleeding of nonorganic cause. Obstet Gynecol. 1985;66(2):225-8.

Downloads

Published

2020-06-25

Issue

Section

Original Research Articles