COMPARISON OF DIAGNOSTIC TECHNIQUES USED IN THE DIFFERENTIAL DIAGNOSIS OF ENDOMETRIAL PATHOLOGIES PRESENTING WITH AN ABNORMAL UTERINE BLEEDING

Öz

Introduction: Transvaginal ultrasonography ( TVUSG ) examination, dilatation and curettage ( D&C ) approach and hysteroscopic assesment are frequently used in examination of the abnormal uterine bleeding ( AUB ). The specisific test for detection of the AUB is histopathological evaluation. The study aimed to check the exactness of TVUSG, D&C and hysteroscopy for differential diagnosis of the AUB. Patients and Methodology: Subjects with AUB, who were supposed to have an endometrial pathology on TVUSG, D&C or hysteroscopy, were included in this retrospective study. Our retrospective study was conducted in 160 patients who were admitted to our clinic with complaint of abnormal uterine bleeding. The final pathological diagnosis was accepted as the reference test and sensitivity and specifity of the D&C, hysteroscopy and TVUSG was checked with the pathological diagnosis. Results: Hysteroscopy combined with biopsy provieded highest correlation with the histopathological evaluation. However, the statistical values obtained with TVUSG was comparable to that of the hysteroscopy alone and D&C but lower than that of the hysteroscopy combined with biopsy. Conclusion: Transvaginal ultrasound is a readily available and reproducible imaging technique for the evalution of the endometrial pathologies leading to the AUB. However, the specificity of the TVUSG is quite low. Among the methods used to correctly identify the endometrial pathologies in our study population, the highest sensitivity and specificity was obtained with hysterosopy combined with the biopsy. Nevertheless, TVUSG provides similar statistical values compared to hysteroscopy alone and D&C.

Anahtar Kelimeler

• abnormal uterine bleeding
• transvaginal ultrasound
• dilatation
• curettage
• hysteroscopy

Anormal Rahim Kanaması İle Başvuran Endometrial Patolojilerin Ayırıcı Tanısında Farklı Tanı Tekniklerinin Karşılaştırılması

Öz

Giriş: Transvajinal ultrasonografi ( TVUSG ) muayenesi, dilatasyon ve küretaj ( D&C ) yaklaşımı ve histeroskopik değerlendirme anormal uterin kanamanın ( AUB ) incelenmesinde sıklıkla kullanılmaktadır. AUB tespiti için özel test histopatolojik değerlendirmedir. Çalışma, AUB'nin ayırıcı tanısı için TVUSG, D&C ve histeroskopinin doğruluğunu kontrol etmeyi amaçladı. Yöntemler: Bu retrospektif çalışmaya TVUSG, D&C veya histeroskopide endometriyal patoloji olması beklenen AUB'li olgular dahil edildi. Son patolojik tanı referans test olarak kabul edildi ve patolojik tanı ile D&C, histeroskopi ve TVUSG'nin duyarlılık ve özgüllüğü kontrol edildi. Sonuçlar: Biyopsi ile kombine histeroskopi, histopatolojik değerlendirme ile en yüksek korelasyonu sağladı. Bununla birlikte, TVUSG ile elde edilen istatistiksel değerler, tek başına histeroskopi ve D&C ile karşılaştırılabilir ancak biyopsi ile kombine histeroskopininkinden daha düşüktü. Sonuç: Transvajinal ultrason, AUB'ye yol açan endometriyal patolojilerin değerlendirilmesi için kolaylıkla temin edilebilen ve tekrarlanabilir bir görüntüleme tekniğidir. Ancak, TVUSG'nin özgüllüğü oldukça düşüktür. Çalışma popülasyonumuzdaki endometriyal patolojileri doğru bir şekilde tanımlamak için kullanılan yöntemler arasında en yüksek duyarlılık ve özgüllük biyopsi ile kombine histeroskopi ile elde edildi. Bununla birlikte, TVUSG, tek başına histeroskopi ve D&C ile karşılaştırıldığında benzer istatistiksel değerler sağlar.

Anahtar Kelimeler

• anormal uterine kanama
• transvajinal ultrason
• dilatasyon
• küretaj
• histeroskopi

Kaynakça

1. 1. Deligdisch L. Hormonal pathology of the endometrium. Mod Pathol. 2000 Mar;13(3):285-94. doi: 10.1038/modpathol.3880050. PMID: 10757339.
2. 2. Stenbäck F, Väänänen R, Kauppila A. Surface ultrastructure of human endometrium. Effect of hormonal status and neoplastic progression. Eur J Obstet Gynecol Reprod Biol. 1980 Oct;11(2):69-84. doi: 10.1016/0028-2243(80)90012-x. PMID: 7192657
3. 3. Committee on Practice Bulletins—Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol 2012; 120:197. Reaffirmed 2016.
4. 4. Edelman A, Micks E, Gallo MF, Jensen JT, Grimes DA. Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception. Cochrane Database Syst Rev. 2014 Jul 29;2014(7):CD004695. doi: 10.1002/14651858.CD004695.pub3. PMID: 25072731; PMCID: PMC6837850.
5. 5. Davis E, Sparzak PB. Abnormal Uterine Bleeding. 2022 Sep 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30422508.
6. 6. McFarlin BL. Ultrasound assessment of the endometrium for irregular vaginal bleeding. J Midwifery Womens Health. 2006 Nov-Dec;51(6):440-9. doi: 10.1016/j.jmwh.2006.06.002. PMID: 17081934.
7. 7. Abdelazim IA, Abdelrazak KM, Elbiaa AA, Al-Kadi M, Yehia AH. Accuracy of endometrial sampling compared to conventional dilatation and curettage in women with abnormal uterine bleeding. Arch Gynecol Obstet. 2015 May;291(5):1121-6. doi: 10.1007/s00404-014-3523-y. Epub 2014 Nov 4. PMID: 25367600.
8. 8. Tsonis O, Gkrozou F, Dimitriou E, Paschopoulos M. Comparative retrospective study on transvaginal sonography versus office hysteroscopy in the diagnosis of endometrial pathology among different subgroups. J Obstet Gynaecol Res. 2021 Feb;47(2):669-678. doi: 10.1111/jog.14580. Epub 2020 Dec 1. PMID: 33258221.

9. 9. Kjerulff KH, Erickson BA, Langenberg PW. Chronic gynecological conditions reported by US women: findings from the National Health Interview Survey, 1984 to 1992. Am J Public Health 1996; 86:195.
10. 10. Munro MG, Critchley HO, Broder MS, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 2011; 113:3.
11. 11. Bayer SR, DeCherney AH. Clinical manifestations and treatment of dysfunctional uterine bleeding. JAMA. 1993 Apr 14. 269(14):1823-8.
12. 12. Demers C, Derzko C, David M, et al. Gynaecological and obstetric management of women with inherited bleeding disorders. Int J Gynaecol Obstet. 2006 Oct. 95(1):75-87.
13. 13. Spencer CP, Whitehead MI. Endometrial assessment re-visited. Br J Obstet Gynaecol 1999; 106:623
14. 14. Motashaw ND, Dave S. Diagnostic and therapeutic hysteroscopy in the management of abnormal uterine bleeding. J Reprod Med. 1990 Jun; 35 (6): 616-20.
15. 15. Mencaglia L, Perino MD (1986). Diagnostic hysteroscopy today. Acta Eur Fertil. 17:431–9.
16. 16. Cacciatore B, Ramsay T, Lehotvirta P, et al. TransvaginalSonography and hysteroscopy in postmenopausal bleeding. Acta Obstet Gynecol Scand 1994;73:413-6.
17. 17. Dijkhuizen FP, Brolmann HA, Potters AE, et al. (1996). The accuracy of transvaginal ultrasonography in the diagnosis of endometrial abnormalities. Obstet Gynecol. 87:345-9.
18. 18. O’Connell LP, Fries MH, Zeringue E, et al. Triage ofabnormal postmenopausal bleeding: a comparision of endometrial biopsy and transvaginal sonohysterographyversus fractional curettage with hysteroscopy. American Journal of Obstetrics and Gynecology 1998; 178: 956 – 61.
19. 19. Karlsson B, Granberg S, Wikland M, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: a Nordic multicenter study. Am J Obstet Gynecol. 1995;172:1488–1494
20. 20. Farquhar C, Ekeroma A, Furness S, et al. Systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Acta Obstet Gynecol Scand. 2003;82:493-504.
21. 21. Feng L, Dingheng L. Evaluation of inrauterine disorders by hysteroscopy and transvaginal sonography Gynaecological endoscopy 2002;11: 401-404
22. 22. Mark H. Emanuel, Marion J. Verdel, Kees Wamsteker, et al. Aprospective comparison of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding: clinical implications. Am J Obstet Gynecol. 1995 Feb;172(2 Pt 1):547-52.
23. 23. Mencaglia L, Perino MD (1986). Diagnostic hysteroscopy today. Acta Eur Fertil. 17:431–9.
24. 24. Philip G. In the menagement of abnormal uterine bleeding is Office hysteroscopy preferable to ultrasonography Journal of Minimal İnvasive Gynecology 2007,14;1:12-14
25. 25. Lo KW, Yuen PM. The role of outpatient diagnostic hysteroscopy in identifying anatomic pathology and histopathology in the endometriyal cavity. J Am Assoc Gynecol Laparosc. 2000 Aug; 7(3): 381-5.
26. 26. Hamou J. E. Hysteroscopy and microcolpohysteroscopy. Text and Atlas P. 99-113 1991.
27. 27. Gimpelson RJ, Rappold HO. A comparative study between panoramic hysteroscopy with directed biyopsies and dilatation and curettage. A review of 276 cases. Am J Obstet Gynecol. 1988 Mar; 158 (3 Pt 1):
28. 28. Goldstein SR, Zeltser I, Horan CK, et al. Ultrasonography-based triage for perimenopausal patients with abnormal uterine bleeding. Am J Obstet Gynecol. 1997;177:102–108.
29. 29. Yücesoy Ġ. Görgen H: Prekanseröz ve kanseröz endometriyum lezyonlarında histeroskopinin diagnostikl değeri. Jinekoloji ve Obstetrik dergisi. 1994: 8: 17-21.
30. 30. de Jong P, Doel F, Falconer A. Outpatient diagnostic hysteroscopy. Br J Obstet Gynaecol. 1990 Apr; 97 (4): 299-303.
31. 31. Gimpelson RJ, Rappold HO. A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and currettage. A review of 276 cases. Am J Obstet Gynecol 1988;158:489-92.
32. 32. Parasnis,H.B., Parulaker,S.U.: Significance of negative hysteroscopic view in abnormal uterine bleeding. J Postgrad Med. 38: 62-64,1992.
33. 33. Madan SM, Al-Jufairi ZA. Abnormal uterine bleeding. Diagnostic value of hysteroscopy. Saudi Med J. 2001 Feb; 22 (2): 153-6.
34. 34. Salim S, Won H, Nesbitt-Hawes E. Diagnosis and management of endometrial polyps: a critical review of the literature. J Minim Invasive Gynecol 2011; 18:569
35. 35. Kılınç H, Cengiiz H, Kaya C, et al. Endometrial Patolojilerin Değerlendirilmesinde Transvajinal Ultrasonografi ile Ofis Histeroskopinin Karşılaştırılması. Yeni Tıp Dergisi 2012; 298 (1) : 23-26.
36. 36. Hedrick Ellenson L, Ronnett BM, Kurman RJ. Precursor Lesions of Endometrial Carcinoma. In: Blaustein's Pathology of the Female Genital Tract, 6th ed, Kurman RJ, Hedrick Ellenson L, Ronnett, BM. (Eds), Springer, New York 2010. p.360-361
37. 37. Lacey JV Jr, Sherman ME, Rush BB. Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia. J Clin Oncol 2010; 28:788.
38. 38. Trimble CL, Kauderer J, Zaino R. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study. Cancer 2006; 106:812
39. 39. Rakha E, Wong SC, Soomro I. Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature. Am J Surg Pathol 2012; 36:1683
40. 40. Attilio Di Spiezio Sardo, Ivan Mazzon, Silvia Bramante, et al. Hysteroscopic myomectomy: a comprehensive review of surgical techniques. Human Reproduction Update, Vol.14, No.2 pp. 101–119, 2008
41. 41. Puri K, Famuyide AO, Erwin PJ. Submucosal fibroids and the relation to heavy menstrual bleeding and anemia. Am J Obstet Gynecol 2014; 210:38.e1.