Comparative study of Diagnostic Accuracy of Hysteroscopy Versus Transvaginal sonography in the evaluation of Abnormal Uterine Bleeding in perimenopausal age group

BACKGROUND: Abnormal Uterine Bleeding (AUB) refers to bleeding that is excessive or occurs outside of normal cyclic menstruation. Evaluation of the endometrium as a cause of AUB is done mainly in three modes i.e. by imaging of endometrium by transvaginal/ transabdominal ultrasound, visual assessment by hysteroscopy and endometrial sampling. INTRODUCTION: AUB is very common Gynaecological problem in a patient attending outpatient department, especially in perimenopausal age group. Thorough investigation is necessary in post menopausal women, where chances of endometrial cancer is10-15%. AIMS AND OBJECTIVES: To evaluate the accuracy of hysteroscopy compared to transvaginal ultrasonography in diagnosing the aetiology of Abnormal Uterine Bleeding. To compare the hysteroscopy and trans vaginal ultrasonography findings with histo-pathological specimen of endometrium obtained by hysteroscopic guided biopsies. METHODS AND MATERIALS: 100 patients were taken for study. Perimenopausal and postmenopausal women with AUB were subjected to Tranvaginal Ultrasound and then to Hysteroscopy and hysteroscopic guided biopsy. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of TVS, HYSTEROSCOPY AND HYSTEROSCOPIC GUIDED BIOPSY to detect intracavitary abnormalities. (with Hysteroscopic guided biopsy as gold standard). RESULTS: Sensitivity, specificity positive predictive value, negative predictive value for detecting abnormal endometrium for TVS is 90%, 87%, 74%, 93% & for hysteroscopy shows 93%, 96%, 90%, 97% respectively. Hysteroscopy is better for intracavitary lesions like polyp and sub mucous fibroid. Trans vaginal ultrasound can identify intra mural fibroid, adenomyosis and adnexal pathology. CONCLUSION: Transvaginal ultrasound is non invasive, cheap, safe and easily available. In the evaluation of AUB, TVS is the first investigation to be done. Hysteroscopy can be better reserved for suspicious case of endometrial lesions.