Evaluation Of Abnormal Uterine Bleeding Research Articles

Abnormal uterine bleeding: Imaging techniques for evaluation of the uterine cavity and endometrium before minimally invasive surgery—the case for transvaginal ultrasonography

Transvaginal ultrasound has been utilized for first line evaluation of abnormal uterine bleeding since its development in the early 1980's. The benefits and diagnostic effectiveness of transvaginal ultrasound in assessing the uterus, unlike hysteroscopy, extends to the complete pelvis. The ease of application, patient acceptance, and immediacy of results are rapidly apparent. Comparisons with hysteroscopic evaluation are discussed. While tissue diagnosis is still the gold standard, transvaginal sonography lets one know what surgical procedure to plan for from hysteroscopy to Endoscopy or laparotomy, including when no further surgical evaluation is necessary.

A new technique to obtain endometrial directed biopsy during sonohysterography: The NiGo device

The primary goal of the clinical evaluation of abnormal uterine bleeding is to establish a specific diagnosis in the most efficient and least invasive manner possible. Hysteroscopy (HS) allows physicians to obtain directed biopsy in addition to direct visualization of the uterine cavity and lesions, but often requires ambulatory surgery centers and some anesthesia, or can potentially result in significant patient discomfort. Sonohysterography (SHG) is less invasive than HS but does not allow a histologic sample. A new technique, called the Nicoletti-Gorlero (NiGo) device, was developed and evaluated to obtain histologic results during SHG. This study is a prospective, observational evaluation between the NiGo device technique and standard HS to obtain endometrial samples. The NiGo device was used to obtain an endometrial sample during SHG in 18 women. In a subsequent session, HS was performed to verify the results. From January 2005 through November 2005 both procedures (SHG + biopsy and HS) were performed on 18 patients. The SHG procedures using the NiGo forcep were performed successfully on 15 out of 18 women, and the endometrial sample was obtained in 14 out of 15 patients. In one patient, the endometrial biopsy obtained provided too little tissue to accomplish histologic evaluation. All 13 pathologic results obtained with the NiGo device were identical with those subsequently obtained with HS. The office-based HS procedure was not successful in two women; in these women, an HS procedure performed in the operating room was necessary. The NiGo device technique allows the physician to obtain sonographic-guided biopsies of the entire endometrium during SHG. The technique is less invasive compared with HS. In our small series, there were no complications during the procedure.

Diagnostic evaluation of Karman endometrial aspiration in patients with abnormal uterine bleeding

To assess sensitivity and specificity of Karman aspiration in the diagnosis of abnormal endometrium compared with the final diagnosis and evaluate tissue adequacy obtained by Karman aspiration. The study group were women who presented with abnormal uterine bleeding to Songklanagarind Hospital between August 2003 and July 2004 and who underwent Karman aspiration prior to conventional curettage. The final diagnosis was defined as the most severe histopathology from either Karman aspiration or conventional curettage. Abnormal endometrium included inflammation, polyp, hyperplasia and malignant changes. Two hundred and twenty-six women were assessed. Endometrial aspiration showed a sensitivity of 89.6% and specificity 100.0% in diagnosis of abnormal endometrium. Abnormal endometrium was detected in 58 women. Of 11 women diagnosed with endometrial cancer, only one case was undetected by Karman aspiration due to a failure to create negative pressure in the uterus. Endometrial aspiration yielded adequate tissue in 86.7%. Karman endometrial aspiration is an accurate and easy procedure, and should be considered in the initial evaluation of abnormal uterine bleeding.

The Evaluation of Abnormal Uterine Bleeding

The Evaluation of Abnormal Uterine Bleeding

Detection of benign endometrial masses by endometrial stripe measurement in premenopausal women.

Our objective was to estimate whether a transvaginal endometrial stripe of less than 5 mm in premenopausal women would exclude endometrial polyps and intracavitary leiomyomata, thereby eliminating the need for sonohysterography. Data from 206 consecutive sonohysterograms performed in premenopausal women with abnormal uterine bleeding between August 1998 and October 2001 were collected retrospectively. Endometrial stripe measurements were obtained in the sagittal plane before sonohysterography. Baseline endometrial stripe images were reviewed by one of the authors, who was blinded to sonohysterography and pathology results, to evaluate for gross endometrial abnormalities on transvaginal ultrasonography. Endometrial stripe measurements were obtained before sonohysterography in 200 of the 206 consecutive exams in premenopausal subjects. Of the 80 subjects with an endometrial stripe measurement less than 5 mm, 11 had endometrial polyps and 5 had submucosal fibroids on sonohysterography. With an endometrial stripe thickness of less than 5 mm, the sensitivity was 74% (95% confidence interval 62-84), the specificity was 46% (95% confidence interval 38-54), the positive predictive value was 37%, and the negative predictive value was 80%. The detection of pathology was not improved by excluding cases with an abnormal-appearing endometrial stripe on the baseline transvaginal images. The use of other endometrial stripe cutoff values did not improve the diagnostic accuracy. Using an endometrial stripe cutoff of 5 mm in premenopausal women would miss significant intracavitary pathology. The sonographic evaluation of abnormal uterine bleeding in premenopausal women should include sonohysterography or equivalently accurate testing regardless of endometrial stripe thickness.

The role of transvaginal colour Doppler sonography in evaluation of abnormal uterine bleeding.

Treatment of abnormal uterine bleeding understands a prompt diagnostic procedure, for the sake of defining the etiological factor of disease. The abnormal uterine bleeding is more common in the perimenopausal than in the postmenopausal women, and it is more frequent sign of an endometrial proliferative or hyperplastic changes. Fewer percentages of women with unexpected and/or acyclic and prolonged bleeding have endometrial cancer. Seventy-one (71) patients with abnormal uterine bleeding, older than 40 years, of which 10 were in post-menopause, have been tested. Prior to explorative curettage and histopathological analysis, ultrasonographic and hemodynamic studies, at the uterine blood vessels level (uterine artery bilaterally) had been performed by transvaginal colour Doppler method. Histopathological results indicated four types of represented changes, on the basis of how the patients were divided into the groups: I, proliferative endometrium--20 patients; II, endometrial adenocarcinoma--23 patients; III, various forms of endometrial hyperplasia--26 patients, IV, atrophic endometrium--2 patients. Significant statistical difference in the endometrial thickness was established between groups I and II, and endometrial cancer was not found in less than 8 mm thick endometrium. By analysing hemodynamic parameters, significantly lower PI values were obtained in the group of patients with pathologically altered endometrium, compared to other groups. Transvaginal colour Doppler has significant role in the diagnostic process for evaluation of abnormal uterine bleeding in perimenopausal and postmenopausal women. Doppler sonography can help in differentiating physiological from malignant endometrial changes and in deciding on the most efficient therapeutical regime.

Evaluation of a clinical skills orientation program for residents

Objective Our purpose was to implement and evaluate an orientation program for residents, focusing on outpatient clinical skills. Study design Eleven of 12 residents participated in a clinical skills orientation program immediately preceding the academic year. The skill stations included evaluation of abnormal uterine bleeding, intrauterine device insertion, basic infertility evaluation, endometrial and vulvar biopsies, pelvic organ prolapse quantification examination, hysterosalpingography and office hysteroscopy, ultrasound scanning, labor and delivery triage, and clinic administrative responsibilities. Before test, after test, and anonymous resident evaluations were used to evaluate the program. Results First-year residents demonstrated a statistically significant increase in posttest scores compared to pretest scores (42.5% vs 71.3%, P = .003). Only first-year resident posttest scores for the labor and delivery triage and basic infertility evaluation stations demonstrated statistically significant increases over pretest scores (14.3% vs 46.4%, P = .009; and 41.7% vs 83.3%, P = .049, respectively). Sixty-four percent of the residents rated the program as “very helpful.” Most residents felt that the program was well organized and that the facilities were conducive to learning; all of the participants recommended an annual clinical orientation program. Conclusion A clinical skills orientation program was well received and strongly desired by residents. First-year residents appeared to benefit the most from this orientation.

Is Outpatient Diagnostic Hysteroscopy More Useful Than Endometrial Biopsy Alone for the Investigation of Abnormal Uterine Bleeding in Unselected Premenopausal Women? A Randomised Comparison

This article presents the results of a randomized, controlled trial comparing diagnostic hysteroscopy and endometrial biopsy in the evaluation of abnormal uterine bleeding. Between August 1996 and October 1999, premenopausal women who were referred to the Aberdeen Royal Infirmary for evaluation of abnormal uterine bleeding were offered the opportunity to participate in the trial. The study subjects were randomly assigned to have endometrial biopsy, which was performed at the first visit using a 3-mm flexible Pipelle, or hysteroscopy in a dedicated hysteroscopy clinic within 2 weeks of their initial clinic visit. There were a total of 370 final study participants. Hysteroscopy was not possible in 28 patients; 19 of these women were evaluated with endometrial biopsy. Cervical stenosis prevented endometrial biopsy in 11 patients, and 6 were unable to tolerate the pain associated with the procedure. The results of a patient questionnaire completed after the evaluation procedure found no significant difference in patient acceptability of either method. The results of the McGill Pain Assessment Questionnaire showed that patients found neither procedure much more uncomfortable than a regular gynecological examination. No endometrial atypia was found in any patient by endometrial biopsy. Of the 178 women who underwent hysteroscopy, a normal endometrial cavity was seen in 123, uterine fibroids were diagnosed in 21, a congenital abnormality was found in 2, and 1 was not evaluable. Further clinical investigation was carried out in nine women under general anesthesia, one of whom was found to have a polyp. Four of the women who were unable to complete endometrial biopsy underwent hysteroscopy under general anesthesia. A submucosal fibroid was found in one, and the findings were normal in the other three. In the 178 patients who underwent hysteroscopy, 11 were diagnosed with endometrial polyps, and 22 were diagnosed with uterine fibroids. There was no statistically significant difference in the rate of uterine abnormality between women with irregular bleeding patterns and those with regular patterns. Hysteroscopic findings had no influence on subsequent management of patients. There were no directed resections for fibroids or polyps identified by diagnostic hysteroscopy, and endometrial ablation or resection was performed only at the patient's request. Not all women with endometrial polyps or fibroids received further treatment. Five percent of the hysteroscopy group and 4% of the endometrial biopsy group underwent hysterectomy. At follow-up 6 months to 1 year after evaluation of abnormal bleeding, 11% women, equally represented in both groups, had changed their treatment program, either by stopping medication or undergoing endometrial ablation.

The Accuracy of Endometrial Biopsy and Saline Sonohysterography in the Determination of the Cause of Abnormal Uterine Bleeding

This study was conducted to investigate the use of endometrial biopsy and saline sonohysterography in the evaluation of abnormal uterine bleeding. The results of this combination were compared with pathologic results from hysteroscopy/ dilatation and curettage or hysterectomy. Study participants were women aged 25 to 69 years with persistent uterine bleeding despite at least 3 months of medical treatment. Of 144 women who entered the study, 30 did not complete the protocol, including 1 who could not tolerate the pain associated with saline sonohysterography and 20 who did not have surgical treatment. One hundred thirteen patients had an initial endometrial biopsy 6 or 7 weeks before saline sonohysterography. Sonohysterography was performed by placing an inflatable balloon catheter in the cervix. After the balloon was inflated with approximately 2 ml of sterile water, a transvaginal ultrasound probe was inserted into the vagina; the uterine cavity was further distended with 10 to 20 ml of sterile saline solution during the ultrasound examination. Forty-seven women (41.6%) had normal surgical findings (secretory, proliferative, or atrophic endometrium). Sixty-six women had abnormal histopathologic findings, including 37 benign and 2 malignant endometrial polyps. One malignant and 22 benign submucosal myomas were diagnosed. Four women had endometrial hyperplasia. Endometrial biopsy and sonohysterography correctly identified 64 patients with abnormal pathology but failed to diagnosed 2 patients with intrauterine pathology; it did predict negative findings in 2 women who were positive in the surgical specimen. The combination also overdiagnosed 14 women as positive who had negative surgical specimens. Thirty-three patients were correctly identified as negative. The sensitivity and specificity of endometrial biopsy and saline sonohysterography were 0.970 (0.886-0.995) and 0.702 (0.550-0.822), respectively. The positive and negative predictive values were 0.821 (0.714-0.895) and 0.943 (0.796-0.990), respectively.

Hysteroscopy: Past, Present and Future.

Hysteroscopy: Past, Present and Future.

Imaging Techniques for Evaluation of the Uterine Cavity and Endometrium in Premenopausal Patients Before Minimally Invasive Surgery

A literature review compared the diagnostic effectiveness and accuracy of transvaginal sonography (TVS) hysterosonographic examination (HSE), hysteroscopy (HY), and magnetic resonance imaging (MRI) in abnormalities of the uterine cavity and endometrium in premenopausal patients referred to surgery and women with abnormal uterine bleeding. The studies varied much in terms of patient selection, number of observers, blinding and experience of observers, and definition of abnormality criteria. The diagnostic effectiveness of the techniques reviewed varied: TVS only reached intermediate quality levels as a diagnostic tool for exclusion of uterine cavity abnormalities and no data support that MRI, TVS, HY, or HSE may exclude hyperplasia without concomitant endometrial sampling. HY and HSE were equally effective and apparently outperformed TVS, especially for identification of polyps. However, all techniques carried a significant number of false positive results. MRI does not satisfy current diagnostic demands for detection of endometrial abnormalities, but it is sufficiently accurate for submucous myoma (SM) evaluation. TVS, HSE, and HY carry much observer variation as opposed to MRI. In experienced hands TVS should be a first choice modality, but its precision and consistency fall short of current needs and it should therefore be supplemented by other techniques. HSE or HY performed by experienced clinicians should be used as supplements to TVS for exclusion of polyps. MRI can be recommended as the first choice modality for exact evaluation of SM uterine in-growth before advanced minimal invasive treatment of myomas. Clinicians should be aware that modern imaging techniques may yield highly idiosyncratic results when used by inexperienced staff, and efforts should be made to reduce such observer variation. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to describe the diagnostic strengths and weaknesses of the various diagnostic tests in the evaluation of abnormal uterine bleeding and to compare the accuracy of each test to the others.

Imaging techniques for evaluation of the uterine cavity and endometrium in premenopausal patients before minimally invasive surgery.

A literature review compared the diagnostic effectiveness and accuracy of transvaginal sonography (TVS) hysterosonographic examination (HSE), hysteroscopy (HY), and magnetic resonance imaging (MRI) in abnormalities of the uterine cavity and endometrium in premenopausal patients referred to surgery and women with abnormal uterine bleeding. The studies varied much in terms of patient selection, number of observers, blinding and experience of observers, and definition of abnormality criteria. The diagnostic effectiveness of the techniques reviewed varied: TVS only reached intermediate quality levels as a diagnostic tool for exclusion of uterine cavity abnormalities and no data support that MRI, TVS, HY, or HSE may exclude hyperplasia without concomitant endometrial sampling. HY and HSE were equally effective and apparently outperformed TVS, especially for identification of polyps. However, all techniques carried a significant number of false positive results. MRI does not satisfy current diagnostic demands for detection of endometrial abnormalities, but it is sufficiently accurate for submucous myoma (SM) evaluation. TVS, HSE, and HY carry much observer variation as opposed to MRI. In experienced hands TVS should be a first choice modality, but its precision and consistency fall short of current needs and it should therefore be supplemented by other techniques. HSE or HY performed by experienced clinicians should be used as supplements to TVS for exclusion of polyps. MRI can be recommended as the first choice modality for exact evaluation of SM uterine in-growth before advanced minimal invasive treatment of myomas. Clinicians should be aware that modern imaging techniques may yield highly idiosyncratic results when used by inexperienced staff, and efforts should be made to reduce such observer variation. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader will be able to describe the diagnostic strengths and weaknesses of the various diagnostic tests in the evaluation of abnormal uterine bleeding and to compare the accuracy of each test to the others.

The accuracy of endometrial biopsy and saline sonohysterography in the determination of the cause of abnormal uterine bleeding

Objective: The purpose of this study was to determine the accuracy of outpatient endometrial biopsy and saline sonohysterography for the evaluation of abnormal uterine bleeding. Study Design: Eligible participants included women aged 25 to 69 years who complained of persistent uterine bleeding, despite medical treatment. One hundred forty-four patients consented and were followed up prospectively: 1 patient did not successfully complete a saline sonohysterography because of discomfort, 143 patients underwent an endometrial biopsy and saline sonohysterography as outpatients, 113 patients underwent a definitive surgical intervention (hysteroscopy/dilatation and curettage or hysterectomy), 20 patients did not complete a gold standard measure, and 10 patients were lost to follow-up. Results: The combination of endometrial biopsy and saline sonohysterography for the 113 patients who completed the study had a sensitivity and specificity for the detection of abnormal pathologic features of 97.0% (95% CI, 88.6-99.5) and 70.2% (95% CI, 55.0-82.2) and a positive and negative predictive value of 82.1% (95% CI, 71.4-89.5) and 94.3% (95% CI, 79.6-99.0) compared with hysteroscopy/curettage or hysterectomy. Conclusion: The high sensitivity and high negative predictive value of saline sonohysterography combined with endometrial biopsy make this technique useful for the evaluation of abnormal uterine bleeding. It may allow some patients to avoid more invasive operative procedures; however, it is important to recognize the limitations in the predictive value of this diagnostic modality. (Am J Obstet Gynecol 2002;186:858-60.)

Obstetric iatrogenic arterial injuries of the uterus: diagnosis with US and treatment with transcatheter arterial embolization.

Uterine curettage or surgical trauma can cause uterine vascular abnormalities, including pseudoaneurysms, acquired arteriovenous malformations (AVMs), arteriovenous fistulas, and rupture of vessels. Recognition of these abnormalities as the cause of hemorrhage is important, since these abnormalities can be treated safely and effectively with transcatheter arterial embolization but may be worsened by uterine curettage, precipitating massive uterine bleeding. Ultrasonography (US) is the most commonly performed initial imaging examination for evaluation of abnormal uterine bleeding. Color and duplex Doppler US allows convincing detection and diagnosis of these vascular abnormalities and helps differentiate vascular abnormalities that require embolization from nonvascular abnormalities. In cases of pseudoaneurysms, color and duplex Doppler US shows a blood-filled cystic structure with swirling arterial flow. In cases of AVMs, color Doppler US shows an intense vascular tangle, whereas duplex Doppler US shows low-resistance, high-velocity arterial flow. Cases of an AVM combined with a pseudoaneurysm demonstrate the findings of both AVMs and pseudoaneurysms. Transcatheter arterial embolization after angiography is the therapy of choice for these vascular abnormalities, with the advantage of retained reproductive capacity. Routine use of color and duplex Doppler US during examination of abnormal uterine bleeding is recommended to identify and characterize the vascular abnormality.

Clinical Pathway for Evaluating Women With Abnormal Uterine Bleeding

Abnormal uterine bleeding is one of the most common gynecologic complaints, generating one-fifth of all visits to the gynecologist and accounting for up to one-fourth of hysterectomies performed in the United States each year. A careful evaluation of this condition is important because endometrial cancer is diagnosed in 10% of postmenopausal women with abnormal bleeding and is a plausible possibility in premenopausal women who present with this symptom. The authors have developed a cost-efficient, risk-based clinical pathway for evaluation of abnormal uterine bleeding. This article is a report of 1000 patients with abnormal uterine bleeding who were seen at the Women's Care Clinic in Denver over a 3-year period and who were managed using this protocol. The women were grouped according to menopausal status (570 premenopausal and 430 postmenopausal) and the presence of risk factors for endometrial cancer, including obesity (43%), nulligravidity (12%), history of anovulation (27%), diabetes (14%), hypertension (15%), or tamoxifen therapy. Patients with one or more of these characteristics were considered high-risk for endometrial cancer and underwent endometrial biopsy. The clinical pathways followed for premenopausal and postmenopausal women are presented in Figures 1 and 2. Four hundred thirty women (44%) were successfully treated medically and did not require endometrial biopsy. The remaining 530 women had endometrial biopsy performed, and 250 of these (90 premenopausal and 160 postmenopausal) were also evaluated with ultrasonography. Biopsy results revealed 40 women with simple hyperplasia, 5 with atypical hyperplasia, and 5 with endometrial cancer. Overall, endometrial biopsy was avoided in nearly 50% of the patients. Physician compliance with the protocols was greater with high-risk patients (77% overall and 88% in postmenopausal patients) than with low-risk patients (42%).

The use of transvaginal ultrasonography, sonohysterography, and endometrial biopsy as a diagnostic tool in the evaluation of abnormal uterine bleeding.

Objective: To determine the sensitivity, specificity, predictive value of a positive and a negative test, of transvaginal (TV) ultrasonography (U/S), sonohysterography (SHG), and endometrial biopsy in the evaluation of abnormal uterine bleeding (AUB). Design: Volunteers with AUB were recruited in a prospective fashion. Patients underwent pelvic exam, TV U/S, SHG, and endometrial biopsy. Within two months of these studies they underwent hysteroscopy. Volunteers were also recruited from those patients undergoing routine hysteroscopy. These results of all preoperative studies were compared directly to hysteroscopic findings. Materials/Methods: Volunteers underwent U/S exam with an ULTRAMARK 4 ©(ATL) US machine with a 5.0/7.5 MHz transducer. Measurements of the uterine and ovarian size, bilayer endometrial stripe thickness, and the presence of abnormalities were recorded. An SHG was then performed with a 5.0F H/S catheter© (Ackrad Lab Inc., Cranford, N.J.) and 10–20 cc’s of sterile saline. The uterus was systematically visualized in saggital and coronal planes. If present any polyps, submucosal myomas, or other abnormalities were measured, and their locations within the uterus and cavity noted. Endometrial biopsies were obtained in the standard fashion with a 5 mm pipelle instrument in the month prior to the U/S studies. TV U/S, SHG, and endometrial biopsy results were compared to hysteroscopic findings. All hysteroscopies were performed in the operating room with standard distension media within 2 months of the U/S studies. Results: 259 women underwent SHG. 109 patients had no intracavitary lesions identified on SHG; 104 elected a change in medical management, 3 had in office D + C’s for focal endometrial thickening and were found to have simple focal hyperplasia, two conceived with ART. The remaining 150 patients underwent office (132) or OR (18) SHG’s. Eleven patients with known abnormal office SHG’s went directly to hysterectomy; 6 myomas, 3 adenomyosis, and 2 persistent menorrhagia and anemia. Three patients with suspected endometrial pathology on SHG did not go to hysteroscopy;1 delayed surgical treatment for complex medical illness, 1 declined surgical intervention, and 1 moved out of the area and was lost to follow up. Of the 136 patients who underwent SHG, and hysteroscopy, 74 had endometrial biopsies. Results of individual tests in the evaluation of DUB. Tabled 1TV U/S (%)SHG (%)Endo Bx (%)Sensitivity559821Specificity51938PV (+)939787PV (−)49953 Open table in a new tab Conclusions: These results indicate that SHG is superior to routine TV U/S and endometrial biopsy in the diagnosis of intrauterine pathology. Endometrial biopsy was most likely to make the diagnosis correctly for hyperplasia, carcinoma, and occasionally for endometrial polyps. The SHG improved the accuracy in differentiating between intracavitary myomas and polyps, and in the location of the lesion. Supported by: ACOG/Tambrands Grant for Menstrual Health.

Transvaginal ultrasonography sonohysterography and operative hysteroscopy for the evaluation of abnormal uterine bleeding

To evaluate the diagnostic accuracy of transvaginal ultrasonography, sonohysterography and hysteroscopy in patients presenting with abnormal uterine bleeding. Prospective, blind, comparative study. Outpatient clinic and day surgery unit of a district hospital specializing in operative hysteroscopy. One hundred consecutive patients referred with abnormal uterine bleeding (AUB). Transvaginal ultrasonography and sonohysterography were performed in the outpatient clinic. Within 1 week, all patients underwent operative hysteroscopy. All diagnoses established by transvaginal ultrasonography, and sonohysterography were compared to the appearance of the cavity using hysteroscopy as well as the histological diagnosis from removed tissues. In 88 patients information suitable for analysis was obtained by all methods. The detection rate of focal intrauterine pathology using sonohysterography was (94.1%), but was significantly lower with transvaginal ultrasonography (23.5%). In about 75% of all cases none of the methods used was able to correctly detect endometrial hyperplasia. Sonohysterography was significantly better than transvaginal ultrasonography in detecting focal intrauterine pathology. Visual examination at operative hysteroscopy yielded no additional information to the detection or exclusion of focal lesions than was obtained at outpatient sonohysterography. All methods performed equally in assessing endometrial pathology. We conclude that sonohysterography may replace diagnostic hysteroscopy in many patients with AUB.

The accuracy of endometrial biopsy and saline sonohysterography in determining the etiology of abnormal uterine bleeding

Objective: To compare the results of endometrial biopsy and saline sonohysterography to that of D & C/hysteroscopy or definitive surgery in the evaluation of abnormal uterine bleeding. Methods: The study protocol was approved by the Human Investigation Committee. The patient population studied consisted of women presenting to outpatient services complaining of a history of abnormal uterine bleeding who had failed conservative medical management. The study consisted of two arms with a combined total of 120 patients. The prospective arm included 91 patients who underwent endometrial biopsy and saline sonohysterography as outpatients before being evaluated by a definitive surgical procedure such as D & C/hysteroscopy with or without thermal balloon ablation or hysterectomy. The retrospective group included 41 patients who before the initiation of this study had endometrial biopsies and saline sonohysterography performed with subsequent definitive surgical procedures. These charts were reviewed retrospectively and included in the results as a separate group. All saline sonohysterographies and procedures were performed under supervision of the attending staff. Results: The combination of endometrial biopsy and saline sonohysterography had a sensitivity and specificity of 96.2% and 65.7%, respectively. The positive predictive value of a saline sonohysterography study showing an endometrial polyp, submucous myoma, or irregular endometrial contour was 80.6%. A normal saline sonohysterography had a negative predictive value of 92.0%. Conclusions: Endometrial biopsy and saline sonohysterography are useful for the evaluation of abnormal uterine bleeding; however, it is important to recognize the limitations in the predictive value of this diagnostic modality.

Transvaginal ultrasonography sonohysterography and operative hysteroscopy for the evaluation of abnormal uterine bleeding

Transvaginal ultrasonography sonohysterography and operative hysteroscopy for the evaluation of abnormal uterine bleeding

Clinical effectiveness of hysteroscopy in abnormal uterine bleeding

The introduction of intrauterine endoscopy has allowed clinicians to evaluate an area of the body that was previously accessible only by the procedure of blind dilation and curettage (D&C). Many studies have shown hysteroscopy to be superior to D&C, yet its use has yet to be appreciated adequately. The use of hysteroscopy has been most common in the evaluation of abnormal uterine bleeding. This study showed that the most common indication for hysteroscopy was abnormal uterine bleeding (98%). Hysteroscopy was performed successfully in 91% of cases and a complete view of the uterine cavity was obtained. Intrauterine pathology was diagnosed in 60%, the highest incidence being found in those between 40 and 60 years old (80%). The presence of endometrial polyps was the most common abnormality (27·3%; n =105), and increased with age to 20% in women over 60 years. Conversely the incidence of fibroids decreased with age; only 5% in women older than 60 years. Endometrial biopsy was performed in all patients and produced adequate tissue for histological examination in 50%. Endometrial hyperplasia and carcinoma was detected in 9·9%. Sixty-three women underwent a minor hysteroscopic procedure.