ROLE OF TRANSVAGINAL ULTRASOUND IN IDENTIFYING ENDOMETRIAL HYPERPLASIA
AbstractBackground: Transvaginal sonography (TVS) is one of the diagnostic modalities used to evaluate endometrial pathologies in women with abnormal uterine bleeding. It permits use of high frequency ultrasound waves at greater proximity to the uterus. This study aimed at determining the diagnostic accuracy of TVS in identifying endometrial hyperplasia by comparing with histologic findings in perimenopausal women with abnormal uterine bleeding. Methods: This cross-sectional study was conducted in Department of Obstetrics & Gynaecology, Unit II, Fauji Foundation Hospital, from Sep 2011 to Mar 2012. A total of 263 perimenopausal women aged 40–50 years with abnormal uterine bleeding in the form of menorrhagia, metrorrhagia and polymenorrhagia were enrolled. Thickness of the endometrium was first measured by ultrasound and then was later confirmed by sampling of endometrium. The outcome was measured in terms of accurately diagnosing endometrial hyperplasia by TVS and then using histologic findings as gold standard to confirm. Results: The mean age of selected patients was 45.3±3.2 years. Out of total 263 cases, 129 (49.0%) presented with menorrhagia, 120 (45.6%) presented as metrorrhagia while 14 (5.3%) had polymenorrhagia. The sensitivity and specificity of TVS was 100.0% and 63.7% respectively. Similarly positive predictive value (PPV) and negative predictive value (NPV) were 56.3% and 100.0% respectively. Diagnostic accuracy of TVS in identifying endometrial hyperplasia using histopathology as gold standard was found to be 75.6%. Conclusion: TVS has a moderate diagnostic accuracy in detecting endometrial hyperplasia. Due to the fact that transvaginal ultrasound is safe, acceptable and easily available in most secondary and tertiary care settings and is non-invasive in nature, in our opinion TVS is to be used as a 1st line diagnostic tool in patients who present with abnormal uterine bleeding.Keywords: Diagnostic accuracy, TVS, endometrial hyperplasia, perimenopausal women
Yasmin F, Farrukh R, Kamal F. Efficacy of pipelle as a tool for endometrial biopsy. Biomedica 2007;23:116–9.
Schappert SM. Ambulatory care visits to physician offices, hospital outpatients and emergency departments: United States, 1996 National Center for Health Statistics. Vital Health Statistics 1998;134:1–37.
Najeeb R, Awan AS, Bakhtiar U, Akhter S. Role of TVS in assessment of abnormal uterine bleeding in perimenopausal age group. J Ayub Med Coll Abbottabad 2010;22:87–90.
Ozdemir S, Celik C, Gezginc K, Kiresi D, Esen H. Evaluation of endometrial thickness with transvaginal sonography and histopathology in premenopausal women with abnormal vaginal bleeding. Arch Gynaecol Obstet 2010;282:395–9.
Imran S, Musonda P, Ewies AA. Premenopausal bleeding: when should the endometrium be investigated? A retrospective non comparative study of 3006 women. Eur J Obstet Gynecol Reprod Biol 2010;148:86–9.
Takreem A, Danish N, Razzaq. Incidence of endometrial hyperplasia in 100 cases presenting with polymenorrhagia/ menorrhagia in perimenopausal women. J Ayub Med
Coll Abbotabad 2008;21:60–3.
Fleischer AC, Kalemeris GC, Machin JE, Entman SS, JamesAE Jr. Sonographic depiction of normal and abnormal endometrium with histopathologic correlation. J Ultrasound Med 1986;5:445–52.
Smith Brindman R, Kerlikowske K, Felstein VA, Subak L, Scheidler J, Segal M, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 1998;280:1510–7.
Aslam M, Ijaz L, Tariq S, Shafqat K, Mehr-un-Nisa, Ashraf R et al. Comparison of TVS and saline contrast sonohysterography in women with AUB: Correlation with hysteroscopy and histopathology. Int J Health Sci Qassim Univ 2007;1:17–24.
Balic D, Balic A. Office hysteroscopy, transvaginal ultrasound and endometrial histology: a comparison in infertile patients. Acta Medica Academica 2011;40:34–8.
Dubinsky TJ, Parvey HR, Maklad N. The role of transvaginal sonography and endometrial biopsy in the evaluation of peri and postmenopausal bleeding. AJR Am J Roentgenol 1997;169:145–9.
Fleischer AC. Sonographic assessment of endometrial disorders. Semin Ultrasound CT MR 1999;20:259–66.
Bree RL, Bowerman RA, Bohm-Velez M, Benson CB, Doubilet PM, DeDreu S, et al. US evaluation of the uterus in patients with postmenopausal bleeding: a positive effect on diagnostic decision making. Radiology 2000;216:260–4.
Davis PC, O’Neill MJ, Yoder IC, Lee SI, Mueller PR. Sonohysterographic findings of endometrial and subendometrial conditions. Radiographics 2002;22:803–16.
Farguhar C, Ekeroma A, Furness S, Arroll B. A systematic review of TVS, SHS and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Acta Obstet
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.