Uterine fluid lactate dehydrogenase isoenzyme activity profile

Abstract

Objective The objective of the present study was to evaluate the diagnostic accuracy of the lactate dehydrogenase (LD) isoenzyme activity profile in uterine fluid, and transvaginal ultrasound (TVS) in the detection of endometrial cancer in women with postmenopausal bleeding. Patients and methods A total of 200 postmenopausal women with one or more episodes of vaginal bleeding were included in the study after signing informed consent. The study was approved by the ethics committee of the Faculty of Medicine, Alexandria University, Egypt. Patients with recent endometrial sampling, current hormone replacement therapy, uterine fluid collection at TVS, or clinical signs of endometritis were excluded from the study. The TVS and uterine fluid sampling for the LD isoenzyme analysis were carried out as office examinations. Endometrial thickness was classified as greater than 5 mm or less than 5 mm on TVS. The LD isoenzyme activity profile was described as normal or abnormal. The LD isoenzyme profile was subsequently related to histopathological diagnosis. Patients with endometrial thickness greater than 5 mm on TVS were evaluated with diagnostic curettage, and those with endometrial thickness less than 5 mm were evaluated with office endometrial biopsy. Results Endometrial carcinoma was found in 18 out of 200 patients (9%). In total, 162 (81%) were found to have endometrium greater than 5-mm thickness on TVS. The LD isoenzyme activity profile was abnormal for 38 (19%) patients. Histopathological diagnosis revealed 18 cases with endometrial cancer and 20 cases with no malignancy. The LD isoenzyme activity profile has 100% sensitivity, 90.1% specificity, 45.4% positive predictive value, 100% negative predictive value, and 88.6% accuracy. TVS for 200 postmenopausal women showed that 162 cases had endometrial thickness greater than 5 mm (81%); 18 of them were diagnosed with endometrial carcinoma (9%) and the remaining 144 cases were diagnosed with benign endometrial pathology (72%); 38 cases had endometrial thickness less than 5 mm (19%) and all of them showed no malignancy (P=0.201). The LD profile showed 38 abnormal results (19%); 18 cases of them diagnosed as endometrial carcinoma (9%) and the remaining 20 cases had benign endometrial pathology (10%). The LD profile showed 162 normal results, all of which had no malignancy (P=0.000*). Conclusion LD isoenzyme profile of uterine fluid could be added as a diagnostic tool for endometrial carcinoma of postmenopausal women. It is a reliable and easy, and is highly tolerable for the patients. At the same time, it can be applied as an office technique. LD isoenzyme profile of uterine fluid could be used as a second step after TVS at a cutoff point of 5 mm, which has proved to be highly reliable. The use of these two methods can reduce the need for curettage and hysteroscopy.