Endometrial Study by TVS and It’s Correlation with Histopathology in Abnormal Uterine Bleeding

Abnormal Uterine bleeding (AUB) is a common reason for women of all ages to consult their gynecologist and is the direct cause of a significant health care burden for women, their families and society as a whole.It affects 10-30% of reproductive age women and upto 50 % of perimenopausal women. The most probable etiology of abnormal uterine bleeding relates to the patients reproductive age, as does the likelihood of serious endometrial pathology. The specific diagnostic approach depends on whether the patient is premenopausal, perimenopausal or post menopausal. In Premenopausal women with normal findings on physical examination the most likely diagnosis is dysfunctional uterine bleeding secondary to anovulation and the diagnostic investigation is targeted at identifying the etiology of anovulation. In perimenopausal women, endometrial biopsy and other methods of detecting endometrial hyperplasia or carcinoma must be considered early in investigations. Uterine pathology particularly endometrial carcinoma is common in postmenopausal women with AUB. Thus in this group endometrial biopsy or transvaginal sonography is included in the initial investigation. [Endometrial sampling could be effectively used as the first diagnostic step in AUB, although at times its interpretation is quite challenging to the practicing pathologist]. In perimenopausal women with DUB, dilation and curettage is the most widely used method to obtain a histopathological specimen and detect endometrial pathology. Although in post menopausal women, dilation and curettage is the key investigation to obtain specimen for histopathological study of the endometrium, only 10% of women show significant endometrial pathology. As it is an invasive blind procedure with sampling errors and risk of complications there is a need for noninvasive or minimally invasive technique to study the endometrial pathology. TVS is one such modality which fulfills the above criteria with better visualization of small changes in the endometium. In this study we tried to correlate the efficacy of TVS i.e. Transvaginal Sonography in relation to histopathology of endometrium. Endometrialthickness being taken as the parameter for excluding endometrial abnormalities. Objectievs of the study:To determine the efficacy of TVS indepicting the pattern of endometrium and to correlate the endometrial pattern and thickness by TVS with the endometrial histopathology in perimenopausal women with AUB and thereby to reduce the need of invasive procedure.Material & methods: This was a prospective study done at Gynaecology department of Siddhartha Medical College, Vijayawada, Andhra Pradesh, India, on 55 patients of perimenopausal women with abnormal uterine bleeding from April 2012 to March 2013. Tranvaginal ultrasound was performed independent of phase of menstrual cycle using 7.5 MHZ tranvaginal transducer taking the maximum endometrial thickness in the sagittal plane as parameter. Later histopathological study of the endometrium was done by dilatation and curettage and results were compared with chisquare test and kappastatistics. Analysis of results were done on Ms excel and Epiinfo and results were tabulated.Conlusion:Abnormal uterine bleeding is a common and sometimes a debilitating condition in women of reproductive age. Standardization of related terminology, a systemic approach to diagnosis and investigation and stepwise approach to intervention is necessary. Here in this study we made an effort to compare the efficacy of TVS with endometrial study by Dilatation and curettage in perimenopausal age group of women with AUB. Perimenopause or climacteric phase generally refers to the time period in the late reproductive years usually late 40’s to early 50’s. In the study by Treloar, the average age for entry into the perimenopausal transition was 45.1 yrs.This study showed that with an endometrial thickness cutoff of >8mm. we can avoid dilation and curettage in 40% of women. Further TVS is non invasive, easily accepted by the women without any complications and further we can see the myometrium, endomyometrial junction, adnexae and ovaries in TVS.Thus TVS can be tried as the most cost effective initial test inwomen with abnormal uterine bleeding especially in perimenopausal age group. The maindisadvantage of TVS is technique of measuring the endomentrium and experience of the operator, which will affect the measurements.