A prospective comparison of transvaginal, transabdominal ultrasound and diagnostic curettage in the evaluation of endometrial pathology in Erbil
AbstractBackground and objective: Abnormal uterine bleeding due to endometrial abnormalities is a common diagnostic challenge facing the radiologist and referring gynecologist. This study was aimed to compare the diagnostic performance of transvaginal ultrasound, transabdominal ultrasound and diagnostic curettage in the detection of endometrial pathologies in symptomatic women. Methods: A prospective comparison study of transvaginal ultrasound, transabdominal ultrasound and diagnostic curettage was conducted for evaluation of endometrial pathology in Maternity Teaching Hospital, Erbil city,Kurdistan region of Iraq, from September13th, 2013 to September14th, 2014. The study included 100 women presenting with abnormal uterine bleeding.Ultrasound findings were compared with histopathological results. The statistical package for the social sciences (version 17) was used for data entry and analysis. Results: The mean age (± SD) of sample size was 47 ±8.57 years. The mean parity was 5.17 ± 2.71. The highest percentages of women were in age group 40-59 years (73%). Of the total sample, more than half (52%) had regular cycles, 25% had irregular cycles and 23% were in menopausal state. In more than half of cases the indication for ultrasounds was for menorrhagia, followed by postmenapousal and intermenstrual bleeding (23% and 21%, respectively). Of 98 women (2 women were excluded from analysis), 19% had atrophic endometrium and 67% had endometrial hyperplasia in histopathological finding. Transvaginal ultrasound sensitivity and specificity were 100% and 92.9%, respectively while transabdominal ultrasound sensitivity and specificity were 92.8% and 65%, respectively. Conclusion: Transvaginal ultrasound scanning is an excellent tool for the determination of whether further investigation with histopathological examination of endometrial biopsy is necessary or not for women presented with abnormal uterine bleeding.
Ascher S, Imaoka I, Lage J. Tamoxifen-induced uterine abnormalities: the role of imaging. Radiology 2000; 214: 29-38.
Bree R, Bowerman R, Bohm-Velez M, Benson C, DeDreu S, Punch M. US evaluation of the uterus in patients with postmenopausal bleeding: A positive effect on diagnostic decision making. Radiology 2000; 216: 260–4.
Dangal G. A study of endometrium of patients with abnormal uterine bleeding at Chitwan valley. Kathmandu Univ Med J 2003;1: 110-2.
Dimitraki M, Tsikouras P, Bouchlariotou S, Dafopoulos A, Liberis V, Maroulis G, TeichmannAT.Clinical evaluation of women with PMB. Is it always necessary an endometrial ArchGynecolObstet 2011; 283(2): 261-6.
Ely J, Kennedy C, Clark E, Bowdler N. Abnormal Uterine Bleeding: A Management Algorithm. J AmerBoardFam Med 2006; 19: 590-602.
Fleischer A. Sonographic assessment of endometrial disorders. SeminUltrasoundCT MR 1999 20; 259-66.
Katz V. Benign gynaecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary, ultrasound imaging of pelvic structures. Comprehensive Gynaecology. 6th ed. Philadelphia: Elsevier; 2012.
Nalaboff K, Pellerito J, Ben-Levi E. Imaging the endometrium: disease and normal variants. Radio graphics 2001; 21: 1409-42.
Nutis M, Garcia K, Nuwayhid B, Mulla Z, ElMasri W.Use of ultrasonographic cut point for diagnosing endometrial pathology in postmenopausal women with multiple risk factors for endometrial cancer. J Reprod Med 2008; 53(10): 75.
Pyari S, Rekha P, Srivastava M, Goel M, Pandey. A comparative diagnostic evaluation of hysteroscopy, transvaginal ultrasonography and histopathological examination in cases of abnormal uterine bleeding. J Obstet Gynaecol India 2006; 56: 240–3
Anwer M,Imdad S, Jamal Q. Histopathological Correlation of endometrial Curettage with abnormal uterine bleeding Pattern. J Surg Pak 2004;9 : 21-4
Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol 2003; 188(2): 401-8.
Opolskiene G, Sladkevicius P, Valentin L . Ultrasound assessment of endometrial morphology and vascularity to predict endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm. Ultrasound Obstet Gynecol 2007; 30(3): 332-40.
Hulka CA, Hall D, Mccarthy K, Simeone J. Endometrial polyps, hyperplasia, and carcinoma in postmenopausal women: differentiation with endovaginal sonography. Radiology 1994; 191(3):755-8.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in Zanco J Med Sci is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0).