Endometrial Pathology In Women Research Articles

Uterine blood flow assessment by colour Doppler for prediction of malignant endometrial pathologies in women with abnormal uterine bleeding

Introduction: Colour Doppler has emerged as useful adjunct to transvaginal sonography in evaluation of women with AUB. This study was carried out to evaluate the role of measurement of the Resistance index (RI) and Pulsatility index (PI) of the uterine arteries by Colour Doppler sonography to discriminate between benign and malignant endometrial condition in women with abnormal bleeding.Material and Methods: This prospective analytical study was performed to evaluate 70 women (30-60 years) with AUB. Spiral arterioles flow patterns, Resistance index (with 0.81 as cut off) and Pulsatility index (with 1.83 as cut off) of uterine arteries were analysed by colour Doppler after detailed TVS. They were compared with Histopathological report of Endometrial Aspiration biopsy. Results: 10 patients (14.3%) had RI in malignancy range (> 0.81) and 9 patients (12.9%) had PI in malignancy range (< 1.83). Out of these 8 had both RI and PI in malignancy range. Thus 11 cases (15.7%) having either RI/PI or RI and PI both, in malignancy range were considered to be suspected of malignancy. Out of these 11 cases, 5 patients were diagnosed to have Hyperplasia/Malignancy on histopathology. There were no False Negative cases, making the sensitivity 100% and specificity 90.7% of TVS with colour Doppler. For the vascular patterns, both cases of hyperplasia had scattered vessel pattern and all 3 cases of carcinoma had multiple vessel pattern, making the association of vascular pattern with AUB diagnosis significant (p<0.001).Conclusion: Colour Doppler of the uterine artery and endometrial spiral arteries, improves the diagnostic accuracy of TVS for the prediction of endometrial pathologies and facilitates in screening for malignant and premalignant lesions. Therefore, it is recommended that CDTU with TVS should be used as screening modality in all AUB patient.

Uterine natural killer cells during the implantation window period in women veterans experienced by injury with unrealished reproductive function

Annotation. Against the background of stress and post-traumatic stress disorder (PTSD) in women, changes in the hormonal background improve – the levels of stress hormones and the morphofunctional endometrium, which in their change negatively affect the reproductive health of women in Ukraine. The purpose of this study was to increase the efficiency of diagnosis and treatment of pathology and implantation capacity of the endometrium in women of reproductive age who took part in hostilities and suffered a concussion. Uterine natural killer cells were studied during the implantation window in 487 women of reproductive age who participated in combat operations and suffered concussions, who underwent hysteroscopy with endometrial sampling for histological examination and scanning electron microscopy on the 21st day of menstruation cycle (MC). Of these women, 246 patients – the comparison group – of reproductive age with a history of trauma without post-concussive syndrome and 211 in the main group, women of reproductive age who have consequences of concussion in the form of post-concussive syndrome. 30 conditionally healthy civilian women of reproductive age served as controls. The average age of the examined was 37.08±4.23 years. The period of stay in the combat zone is 60.26±42.21 months, the time since receiving a traumatic brain injury (concussion) is 18.8±9.2 months. Instrumental examination of women included hysteroscopy. The spectrum of MNC cells (CD16+ and CD56+) in the stroma of the endometrium on the 21st day of MC was determined. Microscopy of the preparations and all morphometric studies were performed on an Olympus AX70 Provis microscope (Olympus, Japan) using the image analysis program Analysis 3.2 Pro (Soft Imaging, Germany) according to the recommendations of the software manufacturer. The obtained results were processed using the Statistica 6.0 and Biostat software packages and methods of analytical statistics. It is established that in women military servicemen, participants in combat operations who suffered a concussion, the content of CD56+ and CD16+ cells in the stroma of the endometrium in women with post-concussion syndrome is greater than that in patients without post-concussion syndrome: in the endometrium, which corresponds to the proliferation phase, it is 1.45 (p&lt;0.0001) and 1.64 times (p&lt;0.0001), in the endometrium, which corresponds to the early secretion phase, 1.93 (p&lt;0.0001) and 2.22 (p&lt;0,0001), in the endometrium, which corresponds to the middle phase of secretion, – in 1.61 (p&lt;0.0001) and in 3.42 (p&lt;0.0001), in chronic endometritis – in 1.92 (p&lt;0 .0001) and 1.94 (p&lt;0.0001), with SAHE – in 1.79 (p&lt;0.0001) and 1.51 (p&lt;0.0001), with endometrial polyps – in 1, 60 (p&lt;0.0001) and at 1.56 (p&lt;0.0001). This study proves the need to improve the efficiency of diagnosis and treatment of endometrial pathology in women of reproductive age who participated in hostilities and suffered concussions.

Endometrial Pathology and Reproductive Outcomes in Polycystic Ovary Syndrome (PCOS)

Introduction: The common and key in the pathogenesis of PCOS and chronic endometritis (CE) is the chronic course of inflammation. Persistent damage to the endometrium leads to impaired endometrial receptivity and creates conditions for the development of infertility. The purpose of the study was to identify the most common endometrial pathology in women with PCOS and infertility and to analyze the effectiveness of infertility treatment in women with this pathology, to evaluate reproductive outcomes. Materials and methods: Analyzed 240 case histories of patients of LLC “Clinic of Professor Pasman”, Novosibirsk Clinical Oncological Dispancery for the period 2012-2022, diagnosed with PCOS, Infertility. Patients were included in the study group by random sequential selection. The frequency of occurrence of each of the PCOS phenotypes was analyzed, as well as the prevalence of endometrial pathology. The most common pathology is chronic endometritis, therefore, in addition to the standard methods of treating infertility in PCOS, CE was additionally treated by the following methods: photodynamic therapy (PDT) and the introduction of a macrophage medium into the uterine cavity. Results and discussion: In 61% of cases, hysteroscopy was performed and endometrial pathology was detected, which indicates the need to diagnose the endometrium in women with PCOS, especially before using ART. The most common endometrial pathology is chronic endometritis (61.6%). PDT and the introduction of macrophage medium increase the effectiveness of the treatment of CE and infertility in PCOS. The results obtained indicate a high incidence of PCOS without hyperandrogenism and obesity.

Ultrasound features of endometrial pathology in women without abnormal uterine bleeding: results from the International Endometrial Tumor Analysis study (IETA3).

The primary aim of this study was to describe the ultrasound features of various endometrial and other intracavitary pathologies in women without abnormal uterine bleeding (AUB) using the International Endometrial Tumor Analysis (IETA) terminology. The secondary aim was to compare our findings with published data on women with AUB. This was a prospective observational study of women presenting at one of seven centers specialized in gynecological ultrasonography, from 2011 until 2018, for indications unrelated to AUB. All patients underwent transvaginal ultrasound using the IETA examination and measurement techniques. Ultrasonography was performed as part of routine gynecological examination or follow-up of non-endometrial pathology, or as part of the work-up before undergoing treatment for infertility, uterine prolapse or ovarian pathology. Ultrasound findings were described using the IETA terminology. Endometrial sampling was performed after the ultrasound scan. The histological endpoints were endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma, endometrial intraepithelial neoplasia (EIN), endometrial cancer (EC) and insufficient tissue. The findings in our cohort of women without AUB were compared with those in a published cohort of women with AUB who were examined with transvaginal ultrasound between 2012 and 2015 using the same IETA examination technique and terminology. In this study (IETA3), we included 1745 women without AUB who underwent a standardized transvaginal ultrasound examination followed by either endometrial sampling with histological diagnosis (n = 1537) or at least 1 year of clinical and ultrasound follow-up (n = 208). Of these, 858 (49.2%) women were premenopausal and 887 (50.8%) were postmenopausal. Histology showed the presence of EC and/or EIN in 29 (1.7%) women, endometrial polyps in 1028 (58.9%), intracavitary myomas in 66 (3.8%), proliferative or secretory changes or hyperplasia without atypia in 144 (8.3%), endometrial atrophy in 265 (15.2%) and insufficient tissue in five (0.3%). Most cases of EC or EIN (25/29 (86.2%)) were diagnosed after menopause. The mean endometrial thickness in women with EC or EIN was 11.2 mm (95% CI, 8.9-13.6 mm), being on average 2.4 mm (95% CI, 0.3-4.6 mm) thicker than their benign counterparts. Women with malignant endometrial pathology manifested more frequently non-uniform echogenicity (22/29 (75.9%)) than did those with benign endometrial pathology (929/1716 (54.1%)) (difference, +21.8% (95% CI, +4.2% to +39.2%)). Moderate to abundant vascularization (color score 3-4) was seen in 31.0% (9/29) of cases with EC or EIN compared with 12.8% (220/1716) of those with a benign outcome (difference, +18.2% (95% CI, -0.5% to +36.9%)). Multiple multifocal vessels were recorded in 24.1% (7/29) women with EC or EIN vs 4.0% (68/1716) of those with a benign outcome (difference, +20.2% (95% CI, +4.6% to +35.7%)). A regular endometrial-myometrial junction was seen less frequently in women with EC or EIN (19/29 (65.5%)) vs those with a benign outcome (1412/1716 (82.3%)) (difference, -16.8% (95% CI, -34.2% to +0.6%)). In women with endometrial polyps without AUB, a single dominant vessel was the most frequent vascular pattern (666/1028 (64.8%)). In women with EC, both in those with and those without AUB, the endometrium usually manifested heterogeneous echogenicity, but the endometrium was on average 8.6 mm (95% CI, 5.2-12.0 mm) thinner and less intensely vascularized (color score 3-4: difference, -26.8% (95% CI, -52.2% to -1.3%)) in women without compared to those with AUB. In both pre- and postmenopausal women, asymptomatic endometrial polyps were associated with a thinner endometrium, and they manifested more frequently a bright edge, a regular endometrial-myometrial junction and a single dominant vessel than did polyps in symptomatic women, and they were less intensely vascularized. We describe the typical ultrasound features of EC, polyps and other intracavitary histologies using IETA terminology in women without AUB. Our findings suggest that the presence of asymptomatic polyps or endometrial malignancy may be accompanied by thinner and less intensely vascularized endometria than their symptomatic counterparts. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

The association of fibrocystic breast disease with endometrial histopathological results in abnormal uterine bleeding

Background/Aim: Fibrocystic breast disease (FBD) is the most frequent benign breast disease. Increased estrogen and decreased progesterone concentrations are thought to be involved in the pathogenesis of FBD. But there is insufficient data on benign breast disease and endometrial pathology. This study evaluates the association between FBD and endometrial pathology in women complaining of abnormal uterine bleeding.&#x0D; Methods: This study was designed as a retrospective case-control study. The medical records of women who had endometrial sampling for abnormal uterine bleeding between 2018 and 2020 were evaluated. Patients with FBD were included in the study group, while the first patients who had endometrial sampling after patients with FBD and without breast disease were recruited as the control group. Demographic, laboratory data, and endometrial histopathological results were obtained from hospital records and compared between the groups.&#x0D; Results: In total, 250 women (106 women with FBD and 144 without breast disease) were recruited for the study. There was no statistically significant difference in mean age, gravidity, parity, and BMI between FBD and control groups. Endometrial hyperplasia without atypia (19.8% versus 10.5%, respectively, P = 0.037) and endometrial polyp (12.2% versus 4.8%, respectively, P = 0.033) were found to be significantly increased in patients with FBD than women without the disease. There was no statistically significant difference in terms of other histopathological results between the groups.&#x0D; Conclusion: Evaluation of the endometrium for abnormal uterine bleeding is essential for early diagnosis and treatment of endometrial pathology, especially for endometrial cancer. In this study, we found that women with FBD have an increased risk for endometrial hyperplasia and endometrial polyp. As endometrial hyperplasia is a precursor lesion for endometrial cancer, clinicians should pay attention to and investigate menstrual bleeding abnormalities of women with FBD and should not delay the evaluation of the endometrium.

Risk factors for endometrial pathology in women with breast cancer and tamoxifen treatment

Risk factors for endometrial pathology in women with breast cancer and tamoxifen treatment

The Risk of Endometrial Malignancy and Other Endometrial Pathology in Women with Abnormal Uterine Bleeding: An Ultrasound-Based Model Development Study by the IETA Group

Objectives: The aim of this study was to develop a model that can discriminate between different etiologies of abnormal uterine bleeding. Design: The International Endometrial Tumor Analysis 1 study is a multicenter observational diagnostic study in 18 bleeding clinics in 9 countries. Consecutive women with abnormal vaginal bleeding presenting for ultrasound examination (n = 2,417) were recruited. The histology was obtained from endometrial sampling, D&C, hysteroscopic resection, hysterectomy, or ultrasound follow-up for >1 year. Methods: A model was developed using multinomial regression based on age, body mass index, and ultrasound predictors to distinguish between: (1) endometrial atrophy, (2) endometrial polyp or intracavitary myoma, (3) endometrial malignancy or atypical hyperplasia, (4) proliferative/secretory changes, endometritis, or hyperplasia without atypia and validated using leave-center-out cross-validation and bootstrapping. The main outcomes are the model’s ability to discriminate between the four outcomes and the calibration of risk estimates. Results: The median age in 2,417 women was 50 (interquartile range 43–57). 414 (17%) women had endometrial atrophy; 996 (41%) had a polyp or myoma; 155 (6%) had an endometrial malignancy or atypical hyperplasia; and 852 (35%) had proliferative/secretory changes, endometritis, or hyperplasia without atypia. The model distinguished well between malignant and benign histology (c-statistic 0.88 95% CI: 0.85–0.91) and between all benign histologies. The probabilities for each of the four outcomes were over- or underestimated depending on the centers. Limitations: Not all patients had a diagnosis based on histology. The model over- or underestimated the risk for certain outcomes in some centers, indicating local recalibration is advisable. Conclusions: The proposed model reliably distinguishes between four histological outcomes. This is the first model to discriminate between several outcomes and is the only model applicable when menopausal status is uncertain. The model could be useful for patient management and counseling, and aid in the interpretation of ultrasound findings. Future research is needed to externally validate and locally recalibrate the model.

Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding

Introduction: Transvaginal Sonography has emerged as important modality in investigating AUB, but it cannot diagnose endometrial pathology in absence of histopathology of endometrium. Addition of Color doppler (CDTU) to TVS can help in diagnosis by evaluation of blood flow through vascular patterns and Uterine artery indices. Objective: To evaluate the role of Trans vaginal Ultrasonography and Colour Doppler (CDTU) in abnormal uterine bleeding and correlating them with histopathological diagnosis. Methods: TVS and Colour Doppler were performed in 70 patients with AUB. TVS included evaluation of endometrium, size of uterus, any uterine or adnexal pathology. Vascular pattern of Spiral arteries of endometrium, and uterine arteries was analysed. Uterine artery indices (RI and PI) were calculated. 1.83 was taken as cut off for PI and 0.81 was taken as cut off for RI. The results were then compared with histopathology of endometrium. Results: On TVS, the causes of AUB were Leiomyoma in 17.1%, polyp in 10%, PCOS in 8.5%, Adenomyosis in 5.7%, and Endometrial growth in 2.8%. 11 patients had suspected malignancy by uterine indices of RI ( and PI ) were calculated. 1.83 was taken as cut off for PI and 0.81 was taken as cut off for RI. The results were then compared with histopathology of endometrium. Results: On TVS, the causes of AUB were Leiomyoma in 17.1%, polyp in 10%, PCOS in 8.5%, Adenomyosis in 5.7%, and Endometrial growth in 2.8%. 11 patients had suspected malignancy by uterine indices of RI (&lt;0.81 ) and PI (&lt;1.83) of uterine artery by CDTU. Specificity and Sensitivity of TVS with CDTU for AUB M was 100% and 90.77% respectively. Positive predictive value was 45.45% and negative predictive value was 100%. Conclusion: Colour Doppler of the uterine artery and endometrial spiral arteries with vascular impedance, improves the diagnostic accuracy of TVS for the prediction of endometrial pathologies and facilitates in screening for malignant and premalignant lesions.

Color Doppler and Transvaginal Sonography; Accuracy in the Diagnosis of Endometrial Pathologies in Women with Abnormal Uterine Bleeding: A Cross-sectional Study

Introduction: Abnormal uterine bleeding (AUB) can occur at any age in a woman’s life, and it is more prevalent in the premenopausal age group. Although anovulation is the most prevalent endometrial cause, other major reasons include endometrial hyperplasia, endometrial adenomatous polyps and cancer. For patients of all ages, it is one of the most prevalent presentations in Gynecology OPDs. AUB has a major impact on health-related quality of life, necessitating quick intervention. AUB treatment is difficult without a good diagnosis. As a result, pre-menopausal and post-menopausal women with AUB must have a thorough examination to rule out endometrial cancer. Aim: To assess the role of transvaginal ultrasound and color Doppler tomography (CDTU) in irregular uterine bleeding and correlate these findings with histological diagnosis. Methodology: The present study included 92 individuals with abnormal uterine bleeding (AUB), in those TVS, and Color Doppler was used to evaluate the endometrial pathologies. Endometrium, uterine size and any uterine or adnexal disease were evaluated during the TVS. Spiral arteries of the endometrium and uterine arteries were studied for their vascular patterns. The RI and PI of the uterine artery were determined. For PI, a cutoff of 1.83 was used, while for RI, a cutoff of 0.81 was used. The results were then compared to endometrial histology. Results: According to TVS, (see Table 1) the most common causes of AUB were leiomyoma (15.2%), polyp (12%), PCOS (9.8%), adenomyosis (5.43%) and endometrial development (3.3%). The uterine indicators of RI (0.81) and PI (1.83) of the uterine artery by CDTU revealed 11 patients with probable cancer. For AUB M, the TVS with CDTU specificity and sensitivity was 100 percent and 90.77 percent, respectively. The positive predictive value was 45%, whereas the negative predictive value was 100%. Conclusion: The use of vascular impedance and color Doppler of the uterine artery and endometrial spiral arteries improves the diagnostic accuracy of TVS for the prediction of endometrial diseases. It makes screening for malignant and premalignant lesions easier.

Застосування внутрішньоматкових левоноргестрел-виділяючих систем для зниження ризику виникнення ендометріальної патології у жінок, які отримують тамоксифен (огляд літератури)

Рак молочної залози (РМЗ) є найбільш поширеною злоякісною пухлиною серед жінок, що розвивається в однієї із восьми жінок у розвинених країнах. Більша частина пухлин є гормонально-залежними. П’ятирічна терапія тамоксифеном знижує відносний ризик рецидиву естроген-позитивного РМЗ на 41 %, а ризик смерті — на 34 %. Тим не менш непухлинна та пухлинна патологія ендометрія у пацієнток, які приймають тамоксифен, залишається серйозною медичною проблемою. Деякі клініцисти використовували левоноргестрел-вмісні внутрішньоматкові системи (ЛНГ-ВМС) у жінок із РМЗ, які приймали тамоксифен, з метою попередження ендометріальної гіперплазії. Метою нашої роботи було дослідити, чи мають ЛНГ-ВМС позитивний ефект на ендометріальну патологію у жінок, які отримують гормональну терапію РМЗ тамоксифеном. Аналізувалися публікації, доступні в PubMed і Cochrane, у період з 1990 по 2015 рік, присвячені застосуванню тамоксифену і його побічним ефектам, ЛНГ-ВМС і їх ефектам на ендометрій у жінок, які отримують терапію з приводу РМЗ. Застосування ЛНГ-ВМС з метою профілактики тамоксифен-індукованих гіперплазії/раку ендометрія є досить перспективним, але вимагає більш масштабних дослі­джень для встановлення клінічної ефективності і безпечності такого методу.

Relationship between Transvaginal Ultrasound Endometrial Volume, Body Mass Index and Endometrial Pathology in Women with Postmenopausal Bleeding

Abstract Background Menopause is recognized to have occurred after one year of amenorrhea, for which there is no other obvious pathological or physiological cause. Perimenopause should include the period immediately prior to the menopause (when the endocrinological, biological and clinical features of approaching menopause commence) and the first one year after menopause. Objectives The aim of the study is classification of patients into those with benign endometrial pathology and those with endometrial hyperplasia or carcinoma using endometrial volume and BMI. Patients and Methods This observational cross sectional study was conducted at the Department of Obstetrics and Gynecology in Ain Shams University Hospital from March 2019 till January 2020. The population of this study was 100 menopausal women with postmenopausal bleeding ≥12 months and endometrial thickness by TVUS ≥5 mm. Results According to histopathology of endometrial carcinoma, statistical analysis of our data revealed that age, menopausal duration and BMI were significantly highest. Parity was significantly lowest. Endometrial volume was significantly highest in carcinoma (7.9±2.9 cc). Age, menopausal duration, parity and endometrial volume had significant moderate diagnostic performance in predicting endometrial carcinoma but BMI had significantly low. Age ≥ 62.0, menopausal duration ≥ 11.0 and parity ≤3.0 had low diagnostic characteristics in diagnosis of endometrial carcinoma but endometrial volume ≥ 6.0 had high sensitivity but low other diagnostic characteristics in the diagnosis of endometrial carcinoma. According to histopathology of endometrial hyperplasia, statistical analysis of our data revealed that age, menopausal duration, BMI, parity and endometrial volume had no significant diagnostic performance in the diagnosis of endometrial hyperplasia. Conclusion In our study, analysis of data revealed that the using of transvaginal measurement of endometrial volume is the best predictor of endometrial cancer with a positive correlation with BMI.

Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen.

Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen.

The role of transvaginal and Doppler ultrasound in differentiating benign from malignant endometrial pathologies in women with postmenopausal bleeding

The role of transvaginal and Doppler ultrasound in differentiating benign from malignant endometrial pathologies in women with postmenopausal bleeding

Rate of Significant Endometrial Pathology in Women at Low Risk for Endometrial Hyperplasia or Cancer Presenting with Abnormal Uterine Bleeding.

Background and ObjectivesTo determine the rate of significant endometrial abnormalities in premenopausal women at low risk for endometrial hyperplasia and cancer presenting with abnormal uterine bleeding (AUB).Patients and MethodsThis descriptive study was conducted from January 1, 2016 to March 31, 2019. The inclusion criteria were premenopausal women, 35–50 years, presenting with AUB, low risk for endometrial hyperplasia or endometrial cancer, and having undergone endometrial sampling or uterine curettage. Nulliparous, obesity, diabetes mellitus, polycystic ovary syndrome, chronic anovulation, infertility, tamoxifen therapy and/or a family history of uterine, ovarian, breast and colon cancer were excluded. Data regarding baseline characteristics were collected, and histopathology reports were reviewed.ResultsDuring the study period, 644 subjects were recruited, 557 of whom had adequate endometrial tissue for histopathology study. The pathology demonstrated benign in most cases (96%). The rate of significant abnormal endometrial pathology was 4% (23 cases) including 19 cases of endometrial hyperplasia without atypia (3.3%), and 4 cases of endometrial cancer (0.7%).ConclusionThe rate of significant abnormal endometrial pathology in premenopausal women at low risk for endometrial hyperplasia or endometrial cancer presenting with AUB was very low. This information should be incorporated into the counseling process regarding the risks and benefits of endometrial sampling.

Relation between Human Epididymis Protein 4 and Endometrial Pathology in Women with Postmenopausal Bleeding

Relation between Human Epididymis Protein 4 and Endometrial Pathology in Women with Postmenopausal Bleeding

Comparing endometrial hysteroscopic and histological findings of infertile women with polycystic ovary syndrome and unexplained infertility: A cross-sectional study.

Background Infertility is a critical condition in women with polycystic ovary syndrome (PCOS), caused not only by anovulation but also by endometrial abnormality.ObjectiveThis study aimed to evaluate and compare the hysteroscopic and histological findings of endometrial biopsies in infertile women with PCOS and normal endometrial thickness and women with unexplained infertility (UI).Materials and MethodsThis cross-sectional study compared the initial hysteroscopy and endometrial histological findings of 70 infertile women with PCOS and normal endometrial thickness with those of 35 women with UI. The relationship between endometrial histology and clinical parameters such as including luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, testosterone, prolactin, fasting blood sugar, body mass index (BMI), and infertility duration was analyzed.ResultsThe mean age of women with PCOS was significantly lower than that of women with UI (27.5 4.1 vs. 30 4.5 years, respectively) (p 0.001). The mean BMI was higher in women with PCOS than in women with UI (28.7 4.4 vs. 25.1 3 kg/m) (p 0.001). The hysteroscopic findings of all women with PCOS were normal, whereas 91.4% of women with UI had normal hysteroscopic findings, 2.9% had a polyp, and 5.7% had endometrial thickening. The histological findings of women with PCOS revealed proliferative endometrium in 54.3%, disordered proliferative endometrium in 17.1%, secretory endometrium in 8.6%, and endometrial polyp in 17.1%, whereas these percentages in women with UI were 28.6%, 0%, 54.3%, and 20%, respectively.ConclusionThe hysteroscopic evaluation alone of infertile women might not detect all probable endometrial pathologies in women with PCOS.

Relation between Human Epididymis Protein 4 and Endometrial Pathology in Women with Postmenopausal Bleeding

Objective: To evaluate the value of human epididymis protein 4 (HE4) in predicting endometrial pathology in women with postmenopausal bleeding (PMB). Method: A cohort study included 100 women with PMB. Women with endometrial thickness (ET) &gt;5mm were subjected to hysteroscopic guided fractional curettage (FC) followed by total abdominal hysterectomy and bilateral salpingo‑oophorectomy with or without pelvic lymphadenectomy. After exclusion of 10 patients, the value of serum HE4 was tested in 90 patients for the ability to predict endometrial pathology based on hysterectomy specimen. Results: Level of HE4 showed a significant difference among women with different endometrial pathologies. HE4 showed a significant positive correlation with the severity of the endometrial lesion, with mean values of 38.33±27 pmol/L for atrophic endometrium (11 cases), 51.26±28.59 pmol/L for simple endometrial hyperplasia (SEH, 51 cases), 148.4±67.34 pmol/L for atypical endometrial hyperplasia (AEH, 16 cases) and 390.9±351.72 pmol/L for endometrial carcinoma (EC,12 cases) Using the cut‑off value of 69.5 pmol/L for preoperative HE4 yielded a sensitivity of 75% and a specificity of 88.5% in prediction of EC. Conclusion: HE4 can predict endometrial pathology in women with PMB with a high specificity and a fair sensitivity.

The Prognostic Value of BMI, Serum Glucose, Endometrial Echo Pattern and Uterine Artery Doppler Velocimetry as a Predictor for Endometrial Pathology in Women with Postmenopausal Bleeding (Prospective Observational Study)

Background: Post-menopausal bleeding is a warning sign that accounts for about 5% of all outpatient gynaecologic visits and is a common indication for referral to rapid access clinics because of the fear of underlying malignancy. Endometrial malignancies differ from other malignancies in that early symptomization is common, allowing early cure. Patients and Methods: During the study period, 100 women with post-menopausal bleeding having inclusion criteria were evaluated in Al Hussein University Hospital. For each patient full history, general, abdominal and pelvic examination was performed. Routine pre-operative investigations were done. Patients were divided into four groups: Group 1 included 29 patients with endometrial polyp. Group 2 included 34 patients with endometrial hyperplasia. Group 3 included 21 patients with atrophic endometrium. Group 4 included 16 patients with endometrial carcinoma. Results: As regards the predictive value of BMI, in the study there was a high statistical significance in comparison between the endometrial carcinoma group and all other benign groups. When discussing the predictive value of blood glucose level, in the study there was a high statistical significance in comparison between the endometrial carcinoma group and all other benign groups. It is worth to mention that the predictive value of endometrial thickness, in the study, was with high statistical significance in comparison between the endometrial carcinoma group and all other benign groups providing the highest specificity and sensitivity. At the last the predictive value of uterine artery velocimetry, in the study, was with high statistical significance in comparison between the endometrial carcinoma group and all other benign groups. Conclusion: BMI, blood glucose level, endometrial thickness and uterine artery velocimetry indices, improve the prediction of endometrial carcinoma in women with post-menopausal bleeding.

Функціональні та ендоскопічні методи діагностики внутрішньоматкової патології

Endometrial pathology (EP) is one of the most common problems which complicate the life of women in the late reproductive, menopausal and postmenopausal periods. Today it is proved that EP acts as a premotor background on which cancer processes of the female reproductive system develop. A special role in the verification of EP belongs to non-invasive and invasive methods of investigation, the diagnostic value of which are not the same. The objective: to evaluate the diagnostic effectiveness of the main methods of verification of endometrial pathology in women in the late reproductive and postmenopausal periods. Materials and methods. A comprehensive examination of 162 women with endometrial pathology was conducted. In addition to conventional investigations for all patients at the first stage of the survey transabdominal and transvaginal ultrasonography (TVUSI), subsequent 3D\4D echographies in the sonoelastography (TV-SEG) regime were conducted. At the second stage of examination hysteroresectoscopy with subsequent histological verification of the obtained material was performed. Results. According TVUSI diagnosis of endometrial hyperplasia was set in 162 cases. In 76 patients (59.4%) non-typical form (NF) of EH was diagnosed. In 52 women (40.6%) the diagnosis of HE atypical form (AF) was set. The discrepancy between ultrasound and pathohistological diagnosis was observed in 34 (20.9%) patients. The frequency of EH diagnosis according to TV + SEG was 145 cases (89.5%), which is 10.5% less compared to TVUSI. Increased echogenicity of the endometrium was revealed in 58 (76.3%) women with NF EH, with AF EH this diagnostic criteria was established in 42 (80.1%) patients. Deformation of the uterine cavity relief was detected in 52 (68.4%) patients with NF HE in women with AF HE this ultrasound index was detected in 38 (73.1%) women. Uneven external contour of M-echo was determined in 8 (10.5%) women with NF HE and 14 (26.9%) women with AF HE (p&lt;0.05). During hysteroresectoscopy HE was diagnosed in 154 cases (95.0%). Fibrous polyps were found characteristic for patients in the post- and premenopausal periods. Conclusion. The comparative analysis of diagnostic characteristics revealed that the addition of sonoelastography to ultrasound investigation can reduce the percentage of false results and increase the diagnostic sensitivity of ultrasound in the diagnosis of endometrial hyperplasia from 79.0% to 89.5%. The inclusion of hysteroresectoscopy to the diagnostic algorithm makes it possible to visualize the pathology of the endometrium and obtain a sighting biopsy. This makes it possible to increase the diagnostic sensitivity of ultrasound investigation by the means of sonoelastography from 89.5% to 95.0%. Key words: endometrial pathology, sonoelastography, endometrial hyperplasia, endometrial polyp, hysteroresectoscopy.

EP33.05: Utility of transvaginal ultrasonography in diagnosing endometrial pathologies in women with premenopausal bleeding: single centre experience

EP33.05: Utility of transvaginal ultrasonography in diagnosing endometrial pathologies in women with premenopausal bleeding: single centre experience