Correlation of Transvaginal USG and Endometrial aspiration findings with various menstruation patterns and histopathological examination of Uterus

Bandana Sharma
In: Obsgyne Review: Journal of Obstetric and Gynecology · 2019 · vol. 5(1) , pp. 71–76 · doi:10.17511/joog.2019.i01.13 · W3015539628
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This study found that endometrial aspiration correlated well with histopathological findings of the uterus in patients with abnormal uterine bleeding, with adenomyosis and fibroids being the most common diagnoses.

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This prospective study enrolled 106 consenting patients with abnormal uterine bleeding who underwent endometrial aspiration followed by hysterectomy, with data compared across sociodemographic characteristics, clinical transvaginal ultrasound findings, and hysterectomy specimen histopathology. The study found that most cases were diagnosed as adenomyosis, followed by fibroids, and while ultrasound missed adenomyosis and fibroids in some cases, endometrial aspiration correlated well with the histopathological findings from hysterectomy specimens. A key limitation acknowledged by the design is that correlation depends on cases proceeding to hysterectomy, and ultrasound performance is not perfect despite the added aspiration step. This paper is centrally about endometriosis and/or adenomyosis — it specifically evaluates adenomyosis among patients with abnormal uterine bleeding using transvaginal ultrasound, endometrial aspiration, and histopathology correlation.

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Abstract

Background: Abnormal uterine bleeding (AUB) may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency or duration and occurs in absence of pregnancy and it is a common manifestation of both benign & malignant diseases of the uterus. Material & Methods: This was a prospective study carried out in the department of Obstetrics & Gynecology, Rama Medical College, Mandhana Kanpur during the three-year period from July 2014 July 2017. A total of 106 patients who were willing to participate in the study and had given consent for endometrial aspiration followed by hysterectomy were enrolled for the study. Data were recorded with respect to sociodemographic characteristics, clinical ultrasound and histopathological findings of the study population. Result: Majority of cases of AUB were diagnosed with adenomyosis followed by fibroid. Though ultrasound diagnosis of adenomyosis and fibroid were missed in some cases but the endometrial aspiration correlated well with the histopathological findings on hysterectomized specimen. Conclusion: Every woman presenting with AUB more than 40 Years must undergo endometrial aspiration assessment prior to hysterectomy to rule out any underlying malignancy and every hysterectomy specimen should be sent for final histopathological diagnosis as it is necessary for confirmation of the diagnosis as well as proper management and counseling of the patients.
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Background

Abnormal uterine bleeding (AUB) may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency or duration and occurs in absence of pregnancy and it is a common manifestation of both benign & malignant diseases of the uterus. Material &

Methods

This was a prospective study carried out in the department of Obstetrics & Gynecology, Rama Medical College, Mandhana Kanpur during the three-year period from July 2014 July 2017. A total of 106 patients who were willing to participate in the study and had given consent for endometrial aspiration followed by hysterectomy were enrolled for the study. Data were recorded with respect to sociodemographic characteristics, clinical ultrasound and histopathological findings of the study population.

Result

Majority of cases of AUB were diagnosed with adenomyosis followed by fibroid. Though ultrasound diagnosis of adenomyosis and fibroid were missed in some cases but the endometrial aspiration correlated well with the histopathological findings on hysterectomized specimen.

Conclusion

Every woman presenting with AUB more than 40 Years must undergo endometrial aspiration assessment prior to hysterectomy to rule out any underlying malignancy and every hysterectomy specimen should be sent for final histopathological diagnosis as it is necessary for confirmation of the diagnosis as well as proper management and counseling of the patients. Downloads

References

2. Diagnosis of abnormal uterine bleeding in reproductive-aged women. Practice Bulletin No. 128. American College of Obstetricians and Gynecologists. ObstetGynecol2012;120:197–206. 3. Mahajan N, Aggarwal M, Bagga A. Health issues of menopausal women in North India. J Midlife Health. 2012 Jul;3(2):84-7. doi: 10.4103/0976-7800.104467.[pubmed] 4. Fraser IS, Critchley HO, Munro MG, et al. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. FertilSteril. 2007 Mar;87(3):466-76. DOI:10.1016/j.fertnstert.2007.01.023.[pubmed] 5. Fraser IS, Critchley HO, Munro MG, et al. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding? Hum Reprod. 2007 Mar;22(3):635-43. Epub 2007 Jan 4.DOI:10.1093/humrep/del478 6. Woolcock JG, Critchley HO, Munro MG, et al. Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding. FertilSteril. 2008 Dec;90(6):2269-80. doi: 10.1016/j.fertnstert.2007.10.060. Epub 2008 Feb 6.[pubmed] 7. The FIGO Recommendations on Terminologies and Definitions for Normal and Abnormal Uterine Bleeding. Ian S. Fraser, Hilary O.D. Critchley, Michael Broder, and Malcolm G. Munro. Seminars in Reproductive Medicine 2011;29(5): 383-390 8. Telner DE, Jakubovicz D. Approach to diagnosis and management of abnormal uterine bleeding. Can Fam Physician. 2007 Jan;53(1):58-64.[pubmed] 9. Shukla Mansi, Fonscea Michelle, Kharat Deepali, Tekale Pallavi. A study to correlate histopathological findings in patients with AUB. Int. J Repot Contracept obstetgynaecol 2017 Feb; 6(2): 654-57 10. Talukdar Bharat Mahela Sangita AUB in perimenopausal women: correlation with sonographic findings and histopathological examination of hysterectomy specimens. J Mid life health 2016;7:73-7 11. Jetley S, Rana S, Jairajpuri ZS. Morphological spectrum of endometrial pathology in middle-aged women with atypical uterine bleeding: A study of 219 cases. J Midlife Health. 2013 Oct;4(4):216-20. doi: 10.4103/0976-7800.122242.[pubmed] 12. Shobha PS. Sonographic and histopathological correlation and evaluation of endometrium in perimenopausal women with abnormal uterine bleeding. Int J Reprod Contracept ObstetGynaecol2014;3:113-7 13. KathuriaR, Bhatnagar B. Correlation between D&C, USG and hysterectomy findings in diagnosing a cause for abnormal uterine bleeding. Indian J Clin pract2014;25:466-70 14. Kumar V, Abbass AK, Aster CJ. Female genital tract. In: Robin’s pathological basis of diseases. 9th ed. Philadelphia: WB Saunders 2013; p.628-704. 15. Gupta G, Kotasthane DS, Kotasthane VD. Hysterectomy: A Clinico-pathological Correlation of 500 cases. The Internet Journal of Gynaecology and Obstetrics 2010; 14(1). 16. Khan R, Sultana H. How does histopathology correlate with clinical and operative findings in abdominal hysterectomy?. JAFMC Bangladesh. 2010 Dec; 6(2):17 20. 17. Bhide P, Bhide A. Uterine Adenomyosis. J Obstet Gynecol. 1994; 44(4):612–5.[pubmed] 18. Siedler D, Laing FC, Jeffrey RB Jr, et al. Uterine adenomyosis. A difficult sonographic diagnosis. J Ultrasound Med. 1987 Jul;6(7):345-9.[pubmed] 19. Ascher SM, Arnold LL, Patt RH, et al. Adenomyosis: prospective comparison of MR imaging and transvaginal sonography. Radiology. 1994 Mar;190(3):803-6.[pubmed] 20. Reinhold C, Atri M, Melino A, et al. Diffuse uterine adenomyosis; Morphologic criteria & diagnostic accuracy of endovaginal sonography. Radiology,1995;197;609-14.[pubmed] 21. Sladkevicius P, Valenten L, Marsal K. Endometrial thickness and Doppler velocimetry of the uterine arteries as discriminator of endometrial status in women with postmenopausal bleeding. A comprehensive study. Am J Obstet Gynecol. 1994;171:722-8 22. Singh A, Singh S, Mathur V, Singh K. Transvaginal sonography in dysfunctional uterine bleeding and its correlation with histopathology. J obstetGyunecol of India. 2005;51(6): 116-9

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