Correlation between cytological and histopathological examination of the endometrium in abnormal uterine bleeding (original) (raw)
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Indian Journal of Pathology and Oncology, 2023
Background: Abnormal uterine bleeding (AUB) is a most common gynecological complaint associated with co morbidities that affects quality of life in women. The Aim of the study was to ananlyze the hisopathological patterns of endometrium in women with AUB and to determine the various histopatterns among different age groups of women presenting with AUB. Materials and Methods: This is a prospective study conducted at Government medical college, Anantapuramu, from January 2021 to December 2022.Endometrial samples with clinical diagnosis of AUB, in whom Gestational causes were ruled out, were included in this study, Statistical data ananlysis was done using SSPS software. Results: A total of 360 cases were analyzed. The prevalence of AUB most common in perimenopausal age group women. Mennorhagia (79.8%) was the common bleeding pattern. The bleeding pattern was significantly associated with age groups(p=0.00).The functional cause (64.2%) of AUB was more common than Organic cause (35.8%).The association of functional and organic causes with age group was not significant. The most common histological pattern was the normal cyclical pattern showing proliferative phase (54.1%). 94 cases showed hisopathological pattern of Hyperplasias that are more common among perimenopausal and postmenopausal age groups. Five cases of Endometrial carcinoma were seen among postmenopausal age group. Three cases were Stage IA, two cases were Stage IB. Obesity and hypertension were most common comorbid conditions seen in this study. Conclusion: Endometrial biopsy should be considered during the workup of women with a clinical diagnosis of AUB to exclude organic pathology especially early detection of precursor lesion of malignancy among perimenopausal and post-menopausal age groups. Keywords: Abnormal uterine bleeding, Mennorrhagia, Endometrium, Hyperplasia.
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2020
Introduction: Endometrial pathologies contribute to a large proportion of abnormal uterine bleeding (AUB). The aim of this study was to prospectively validate a novel scoring tool [diseases of endometrium-evaluation and risk scoring (DEERS)] as compared with the gold standard histology. Diseases of endometrium-evaluation and risk scoring is a scoring system based on patient characters and endometrial features that are visualized in gray scale transvaginal sonography (TVS). We hypothesized that this tool will help screen women who present with AUB for premalignant and malignant diseases of endometrium, in a noninvasive way. When performed routinely in women prior to subjecting them to endometrial sampling, it would reduce anxiety for the patient till the final histology report is awaited. It may also be used to help reduce the burden of unnecessary samplings to the clinicians as well as decrease the burden of histological slide review for the pathologist. Materials and methods: A total of 454 women were included. Patients with AUB in whom cervical, myometrial, ovarian, and endocrinal causes were ruled out and were planned for endometrial sampling were recruited for the study, as cases (n = 284). Women who were planned for hysterectomy for reason other than endometrial pathologies were taken as controls (n = 170). Preoperatively patient characteristics were noted, and TVS was performed to calculate DEERS for all. Results: In the study cohort, DEERS showed specificity of 100% for cancers, 88.12% for complex hyperplasia, 67.12% for benign lesions, and 76.35% for normal endometrium. However, the sensitivity of prediction was not encouraging. The 95% accuracy of the test for various lesions ranged from 60 to 97%. We noted a high efficacy (sensitivity of 72.2%, specificity of 92.1%) of DEERS in predicting malignant/premalignant diseases of endometrium, when coupled in one group. Conclusion: This scoring system looks promising for screening endometrial malignancy in women who present with AUB.
Histopathological interpretation of endometrium in abnormal uterine bleeding
International Journal of Medical Science and Public Health, 2014
Background: Abnormal uterine bleeding is one of the most frequent problems in life of an adult female. Accurate analysis of endometrium & localization of intrauterine lesion is the goal to effective management & better outcome of problem. Aims & Objective: To evaluate various histopathological features in D & C and/or hysterectomy in patients presenting with abnormal uterine bleeding and to find the efficacy of D & C as a better, cost effective and minimally invasive tool for screening in patients with AUB. Materials and Methods: The present study was conducted in Department of Pathology, tertiary care hospital, Ahmedabad, Gujarat, India over a period of one and half years. A total 320 patients aged 20 years & above, presenting with AUB were included. Endometrial samples were analysed, histopathological changes identified and classified. Results: Age of patients ranged from 21 to 70 years mean age being 42.6 ± 6.9 years, maximum patients (53.4%) belonged to 41-50 years of age group. Most common histopathological pattern was normal cyclical endometrium (47.3%) followed by endometrial hyperplasia (42.9%). Endometrial hyperplasia was most common (57.1%) in perimenopausal age group (41-50 years). The diagnostic accuracy of D &C was found to be 93.4%; amongst all histopathological patterns it was maximum for complex hyperplasia (typical and atypical) and simple atypical hyperplasia. Conclusion: Endometrial causes of AUB are age related therefore it is specially recommended in women of perimenopausal age group to rule out preneoplastic and neoplastic etiology. D & C is an accurate, minimally invasive outdoor procedure for detecting endometrial pathology especially hyperplasia.
Retrospective examination of endometrial sampling results in women with abnormal uterine bleeding
Journal of Clinical Medicine of Kazakhstan
Background: Abnormal uterine bleeding (AUB) is among the most significant and frequent causes of admission to the gynecology outpatient clinic. AUBs may manifest as the earliest sign of endometrial cancer. For the early detection and treatment of endometrial cancer, careful examination of AUBs is crucial. Aim: The study was conducted to retrospectively evaluate the histopathological results of probe curettage materials applied to women who applied to the gynecology clinic for AUB and were hospitalized with the complaint of AUB. Material and Methods: In the retrospective study planned between 2020 and 2021, all endometrial biopsies from 638 women with AUB reported to the gynecology clinic were reviewed and analyzed. The data were obtained from the archives of our hospital's gynecology and obstetrics clinic and pathology clinic. Results: 638 cases were analyzed. The mean age of the patients was 47.94±9.53 years. Malignant pathology was detected in 20 cases (3.13%). Nineteen of the...
IOSR Journals , 2019
Background: Normal menstrual bleeding occurs from secretory endometrium after ovulation, for a period less than 5 days. Any bleeding not complying with this is considered as abnormal uterine bleeding. Materials and methods: This is an observational study done at a Tertiary Care Center in South Tamil Nadu, in the Department of Pathology from August 2017 to January 2019, over a period of 18months. A total of 134 specimen of endometrial biopsies received, were included in the study. Aims and objectives: This study was conducted to learn the different histomorphological pattern of endometrial biopsies in patients with abnormal uterine bleeding and to find the incidence of carcinoma endometrium in our Government Tertiary Care Center. Later to evaluate the role of histopathological examination in predicting the cause on comparison with ultrasound examination. Results and conclusion: In our study, most common patterns were proliferative phase(31%) followed by secretory phase(22%) and mixed pattern(18%). The incidence of carcinoma endometrium was 3.7% in our Government Tertiary Care Center. Ultrasound diagnosis of thickened endometrium , varied from less than 10mm in functional causes to 15-30millimeters in organic causes but it could not differentiate the definitive cause. On comparison histomorphological analysis were more accurate in diagnosis of functional causes and also differentiates organic causes like carcinoma endometrium from endometrial hyperplasia. Hence endometrial biopsies can be included in the initial evaluation of women with AUB along with ultrasound examination than using it as last modality for diagnostic and therapeutic purpose irrespective of age group.
Spectrum of Endometrial Pathology in Abnormal Uterine Bleeding
https://www.ijhsr.org/IJHSR\_Vol.7\_Issue.9\_Sep2017/IJHSR\_Abstract.05.html, 2017
Background: Abnormal uterine bleeding (AUB) is defined as any alteration in the pattern or volume of menstrual blood flow. It is a very common gynecological condition and has a major impact on quality of life. In many instances it is related to the endometrial pathology. The study was done to evaluate the histopathology of endometrium for identifying endometrial causes of AUB and their incidence in different age groups. Materials and methods: The study was done at a tertiary care institute over a period of one year from 1 st January 2016 to 31 th December 2016. Endometrial samples and hysterectomy specimen of patients with AUB, in whom non-endometrial pathology had been ruled out, were included in the study. The specimens were routinely processed and H&E stained slides were studied for endometrial pattern. Results: Total of 248 cases were received, 150 endometrial tissue samples and 98 hysterectomy specimens. There were 49.2% women in perimenopausal (40-49 years), 26.2% in reproductive (<40 years) and 24.6% in post menopausal age group (>49 years). Well defined organic abnormality was present in 33.9%. Endometrial patterns included cyclic (36.7%), disordered proliferative (16.1%), atrophic (13.3%), chronic endometritis (2.4%), endometrial polyp (8.1%), endometrial hyperplasia (21%) and endometrial carcinoma (2.4%). Conclusions: Patients with AUB show a varying spectrum of endometrial pattern, ranging from cyclic endometrium to carcinomas. It is therefore important to evaluate for endometrial pathology in all women presenting with AUB without a known cause.
Saudi Medical Journal, 2019
Objectives: Abnormal uterine bleeding (AUB) is a leading cause of hysterectomies, the cause of which is usually diagnosed with preoperative endometrial sampling. We planned this study to assess the accuracy of diagnosing the histologic patterns of endometrium in the preoperative sample in reference to the final histologic diagnosis in hysterectomy. Methods: We retrospectively reviewed medical charts between January 2011 and December 2015 at a tertiary hospital in Saudi Arabia and identified 43 cases of AUB with complete documentation. The histologic diagnoses were classified into normal and benign pathology group (N/B), or carcinoma and hyperplasia category (Ca/H). Measures of validity were used to compare endometrial sampling histological diagnoses to diagnoses following hysterectomy and Cohen's kappa to assess for agreement between the 2 modalities. Results: The median age of all patients was 49 years. Preoperative histologic examination showed 53.8% sensitivity, 90% specificity, 70% positive predictive values and 81.8% negative predictive values, 30.1% false positive rates and 18.2% false negative rates. The agreement between preoperative and postoperative histologic diagnoses was moderate (79.1%, k=0.469). Conclusion: The accuracy of preoperative histologic examination was moderate. Our findings recommend cautious clinical decision making and limiting hysterectomy to women who do not respond to other therapeutic measures.
Evaluation of Diagnostic Efficacy of Pipelle Endometrial Sampling in Abnormal Uterine Bleeding
Journal of Clinical and Diagnostic Research, 2018
Abnormal Uterine Bleeding (AUB) is a major clinical problem among women in peri and postmenopausal age groups which need complete scrutiny. Various methods are in vogue for the assessment of endometrium. Histopathological interpretation of endometrial tissue is the gold standard investigation. Studies have raised concern about diagnostic accuracy and adequacy of pipelle endometrial sample. Aim: To compare the efficacy of pipelle endometrial sampling method with conventional Dilatation (D) and Curettage (C) in diagnosis of AUB. Materials and Methods: This comparative cross-sectional study was carried out at DM Wayanad Institute of Medical Science, Kerala, India (January 2016 to June 2017). Endometrial samples collected from 210 patients with AUB initially by pipelle method followed by D and C formed the material for this study. Slides prepared after routine histopathological processing and sectioning. Staining was done by using Haematoxylin and Eosin (H&E) stains and the slides were subjected to thorough and independent microscopic examination for comparative analysis. Data analysis was performed by using IBM SPSS Software version 21.0. Results: Histopathological examination of endometrial samplings by pipelle method revealed endometrial carcinoma in seven cases, atypical endometrial hyperplasia in seven cases, endometrial hyperplasia in 85 cases and disordered proliferative endometrium in 30 cases. These were correlated with histopathological findings of conventional D and C sampling method which showed pipelle sampling method had sensitivity and specificity in endometrial carcinoma (80% and 100% respectively), atypical endometrial hyperplasia (100% and 99.5% respectively), endometrial hyperplasia (100% and 93.98% respectively) and disordered proliferative endometrium (81.1% and 100% respectively). There was significant positive correlation (p<0.01) between the two techniques. Endometrial sampling by pipelle method had a high sensitivity and negative predictive value in diagnosing abnormal endometrium. Conclusion: Endometrial sampling by pipelle method is a safer and simpler alternative for diagnosis of endometrial lesions in patients with AUB. It has a fair degree of diagnostic accuracy almost comparable to that of curettage material. The diagnostic accuracy is high if interpreted by an experienced pathologist.
Comparison of Endometrial Biopsy Results of Premenopausal and Postmenopausal Patients
Middle Black Sea Journal of Health Science, 2020
Objective: To evaluate the histopathological results of endometrial biopsy specimens obtained from patients who referred to our clinic with a complaint of abnormal uterine bleeding (AUB) and to compare the results of premenopausal and postmenopausal patients. Methods: In this retrospective study, the records of patients who referred to our clinic due to AUB between 2013 and 2017, and who had undergone endometrial biopsy with pipelle were evaluated. Demographic data and menopausal status of the patients were recorded. Endometrial biopsy results of all patients were investigated. In addition, the patients were divided into two groups as premenopausal and postmenopausal. Endometrial biopsy results of both groups were compared. Results: While 2808 (56.1%) of the 5000 patients who referred with AUB and who had undergone endometrial sampling were premenopausal, 2192 (43.8%) were postmenopausal. The mean age of the premenopausal and postmenopausal groups was found to be 41.6 ± 1.8 and 54.2 ± 5.9, respectively. Secretory endometrium was significantly higher in the premenopausal group than the postmenopausal group (p <0.001). While atrophic endometrium and malignancy were significantly higher in the postmenopausal group than the premenopausal group, chronic endometritis was significantly higher in the premenopausal group. Conclusion: Endometrial biopsy, which is a simple, inexpensive and easy technique, is the most preferred method for the exclusion of malignancy in patients with complaint of AUB. In patients with complaint of AUB, malignancy exclusion decision by endometrial biopsy must be made considering the age interval, risk factors that may cause estrogen exposure, and menopausal status of the patients.
Diagnostic efficacy endometrial aspiration cytology in gynecological pathology
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Endometrial aspiration cytology is a diagnostic modality for studying cyto-harmonal changes and for evaluating endometrial pathology ranging from inflammatory changes, hyperplasia and endometrial malignancies. Aims: To assess the diagnostic accuracy of endometrial aspiration technique and to compare the cyto-morphology of aspirated smears with histopathology. Materials and Method: Endometrial aspiration was performed using Karman's cannula in 100 cases who presented with abnormal uterine bleed, infertility and postmenopausal bleed. The endometrial specimens obtained by D& C were processed and evaluated histologically. The endometrial aspirated smears were correlated with histopathology findings for diagnostic accuracy. Results: The study cases included 48 patients in reproductive age group and 52 patients in the perimenopausal and postmenopausal age groups. The diagnostic accuracy on cytology was 90% when compared to histology. The smears were inadequate for reporting in eight cases. The sensitivity of endometrial cytology was 93% and specificity was 85.7%. Conclusions: Endometrial aspiration technique with Karman's cannula is convenient, simple, safe and less invasive procedure. The endometrial aspiration cytology proved to be effective diagnostic modality in the interpretation of normal and abnormal endometrium. The present study emphasizes the need for early screening to diagnose pre-invasive lesions and endometrial malignancies in peri-menopausal and post-menopausal patients.