To compare the diagnostic accuracy of hysteroscopy with transvaginal sonography in detection of endometrial polyp and endometrial hyperplasia in peri and postmenopausal women with abnormal uterine bleeding

Abstract

Abnormal uterine bleeding is the most common health problem encountered by women. AUB is a common gynaecological complaint and it may involve females at any age group. 33% of women referred to gynaecology clinics have AUB and the figure rises to 69% in premenopausal and postmenopausal women. Abnormal uterine bleeding accounts for two thirds of all hysterectomies.The present study was prospective cross sectional study conducted in the Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother &Child Indira Gandhi Medical College Shimla for period of one year w.e.f 1st May 2018 to 30th April 2019. The study was started after hospital ethical committee approval.76 patients peri and post menopausal women were enrolled in the study after taking written consent).A detailed history, general and systemic examination was done. All patients underwent transvaginal sonography followed by hysteroscopy and further management was done according to the abnormality detected.Hyperplasia on TVS was present in 15 study subjects i.e 19.7% (14 perimenopausal one postmenopausal). 13 subjects i.e 17.1% on hysteroscopy showed hyperplasia further on histopathology hyperplasia was confirmed in 15 subjects i.e 19.7% (14 had simple hyperplasia one had complex hyperplasia with atypia). On TVS endometrial polyp was seen in 22 subjects i.e 28.9% (18 perimenopausal four post menopausal) Hysteroscopy showed that 27 subjects i.e 35.5% had endometrial polyp (23 peri menopausal four postmenopausal). Further on histopathology endometrial polyp was confirmed to be present in 26 subjects i.e 34.2%. Sensitivity Specificity PPV NPV of Transvaginal sonography versus hysteroscopy for endometrial polyp was 81.5% 100% 100%, 88.6% repectively. For endometrial hyperplasia Sensitivity Specificiy PPV NPV was 100% 96.3% 86.9% 100% respectively.Abnormal uterine bleeding is a problem which women in perimenopausal and postmenopausal period frequently encounter. Of all investigations, TVS is quick, simple, painless, least invasive, less expensive and readily available procedure. Hysteroscopy not only allows direct visual observation of pathology but also provides a means to sample the site, most likely to yield positive results. Hence, it should be made an essential part of diagnostic workup of abnormal uterine bleeding.