Sonographic, hysteroscopic, and pathologic findings in patients with abnormal uterine bleeding

الملخص EN

Abnormal uterine bleeding AUB is the cause of gynecological referral in about 50 % of premenopausal women.

The main aim in investigating this condition is to exclude focal, premalignant, or malignant endometrial disease.

This is achieved via sonographer, hysteroscopy, and pathologic examinations.

Objective : to evaluate the sonographer, hysteroscopy, and pathologic findings in women with A UB in a new one stop clinic.

Design : Prospective, observational study of 240 premenopausal and 55 postmenopausal consecutive patients with abnormal uterine bleeding.

Patients : all patients 35 years or more with AUB not related to pregnancy were included.

Exclusion criteria included active pelvic infection, severe cardiopulmonary co morbidity, cervical cancer, and initiation of contraception within the last 3 months.

Procedure: All the patients had vaginal sonographer examination, office hysteroscopy, and endometrial biopsy on one stop bases.

Outcome : diagnostic indices of the different methods.

Endometrial biopsy was the gold standard for diagnosing hyperplasia or cancer and combined hysteroscopy and biopsy was the gold standard for focal lesion and global endometrial disease.

Results: For focal lesion vaginal ultrasound had 42 % sensitivity, 87 % specificity, 3.2 positive predictive value, and 0.67 % negative predictive value.

Office hysteroscopy had corresponding figures of 91 %, 100 %, 91, and 0.09 respectively.

Endometrial biopsy had corresponding figures of 17 %, 100 %, 17, and 0.83 respectively.

Conclusion : Office hysteroscopy is the gold standard for diagnosing endometrial focal lesions and combined VUS and EB failed to detect more than 50 % of them.

This makes that 14 % of patients wrongly diagnosed of being free of endometrial focal lesion.

So, OH should be included in the initial evaluation of patients with AUB.