Comparison of Transvaginal Ultrasonography with Hysteroscopy taking Endometrial Biopsy

Background: Abnormal uterine bleeding (AUB) is an important cause of ill health in perimenopausal women. Accurate diagnosis of the causative factor of AUB in this age group is of utmost importance so that appropriate management can be established. Objectives: The purpose of our study was to determine the diagnostic accuracy of transvaginal ultrasonography (TVS) and hysteroscopy (HYS) compared with histopathology in women with perimenopausal bleeding. Study design: This is a nonrandomized, purposive sampling and prospective study. Setting: This study was carried out in the Department of Obstetrics and Gynaecology of Dr Susheela Tiwari Memorial Hospital, Haldwani, Nainital district of Uttarakhand. Materials and methods: We included those patients of perimenopausal age group who attended the gynecology department with the complaint of AUB during 18 months of our study period and in whom we were able to do all the three diagnostic modalities from January 2014 to July 2015. Results: In the present study, mean age of patients was 49.56 ± 4.48 years. Maximum patients (41.05%) were in age group of 41 to 45 years, while the least number (9.5%) of patients were in the age group 35 to 40 years. In our study, >5 mm was the cutoff for postmenopausal patients, and >12 mm was for perimenopausal patients. Accuracy rates of HYS for diagnosing all lesions were better than TVS. Both sensitivity and specificity were found to be more for HYS. Conclusion: Our results showed that HYS is a powerful tool for evaluating the endometrial cavity for focal abnormalities, such as endometrial polyps or submucosal fibroids. Hysteroscopy with directed biopsy is the “gold standard” approach for the most accurate evaluation of the endometrium to rule out endometrial carcinoma. ReseaRch aRticle 1,3Junior Resident, 2Professor and Head 1,2Department of Obstetrics and Gynaecology, Government Medical College, Haldwani, Uttarakhand, India 3Department of Community Medicine, Government Medical College, Haldwani, Uttarakhand, India Corresponding Author: Madhulika Gupta, Junior Resident Department of Obstetrics and Gynaecology, Government Medical College, Haldwani, Uttarakhand, India, e-mail: madhulika [email protected] 10.5005/jp-journals-10032-1093 Clinical significance: The TVS can be used as a routine firststep diagnostic technique, but HYS followed by histopathology should be considered as a gold standard for evaluation of abnormal vaginal bleeding.