Evaluation Of Endometrial Pathology Research Articles

Evaluating the Role of Chromohysteroscopy in Evaluation of Endometrial Pathology as a Cause of Abnormal Uterine Bleeding

Evaluating the Role of Chromohysteroscopy in Evaluation of Endometrial Pathology as a Cause of Abnormal Uterine Bleeding

Role of Chromo Hysteroscopy in Evaluation of Endometrial Pathology in Female with Abnormal Uterine Bleeding.

Role of Chromo Hysteroscopy in Evaluation of Endometrial Pathology in Female with Abnormal Uterine Bleeding.

Diagnostic Accuracy of Transvaginal Ultrasound Versus Hysteroscopy in Evaluation of Endometrial Pathology in Breast Cancer Women Receiving Tamoxifen: Correlation with Histopathological Examination

ABSTRACT Background: Multiple endometrial lesions have been reported in tamoxifen -treated breast cancer patients. As a consequence, a thorough uterine cavity examination is often necssary. Objective: To compare the efficacy of transvaginal ultrasound versus hysteroscopy in detecting the endometrial changes in tamoxifen-treated breast cancer patients, and to correlate the findings of both methods with histopathological examination of endometrial biopsies. Patients and methods: Twenty seven patients who had mastactomies for breast cancer and receiving tamoxifen (TAM) were enrolled in this prospective study. They subjected to transvaginal ultrasonography (TVUS) and hysteroscopy for endometrial assessment. Endometrial biopsy was taken from all participants for hitstopathological examination. The ultrasongraphic and hysteroscopic findings were compared and correlated with the histopathological results. Results: The diagnostic accuracy of TVUS versus hysteroscopy in detecting endometrial changes in breast cancer TAM treated women was as follows;TVUS had a sensitivity (82.4%), specificity (30.0%), PPV (66.7%), NPV (50.0%) and accuracy (63%) ;while, the hysteroscope had sensitivity (94.1%), specificity (60.0%), PPV (80.0%), NPV (85.7%) and accuracy (81.5%). Conclusion: Because of certain discrepancies between TVUS and histopathological results in TAM treated women, TVUS is not the best tool for evaluating the endometrium in those patients. The utility of the hysteroscopic image processing helps in the triage of women who require endometrial surveillance, so it will reduce the pathologist's workload and the patient's apprehension while waiting for histopathology result. Nevertheless hysteroscope cannot establish a conclusive diagnosis of premalignant or malignant lesions, but it provides a direct view for targeted biopsies to create a definitive diagnosis.

Current role of Pipelle endometrial sampling in early diagnosis of endometrial cancer.

Endometrial cancer is the most common gynecologic cancer in developed countries. The most prevalent, however not pathognomonic symptom of the disease is abnormal uterine bleeding. The diagnosis of endometrial cancer is based on the histologic results of endometrial sampling. Endometrial biopsy could be obtained using different modalities: hysteroscopy-directed endometrial biopsy, uterine curettage or office endometrial biopsy. Outpatient endometrial biopsy using different devices for the evaluation of abnormal uterine bleeding is gaining popularity. The most popular office-based device for endometrial sampling procedure is the Pipelle device. Currently, Pipelle endometrial sampling is widely used to diagnose endometrial cancer in women with abnormal uterine bleeding and/or postmenopausal bleeding. The method became very useful due to easiness and simplicity of the procedure, availability of a device, as well as high sensitivity in detecting endometrial cancer. Many studies compared the validity and accuracy of Pipelle biopsy with dilation and curettage in the detection of various endometrial pathologies. Published results state that Pipelle biopsy and uterine curettage are almost equally reliable in the evaluation of endometrial pathologies. Moreover, Pipelle biopsy appears more beneficial as it does not require hospital admission and anaesthesia. However, it is proven the Pipelle technique has a limited capacity to identify endometrial polyps, and some authors, based on their study, claim that dilation and curettage is a more reliable method in terms of correlation with the final histological results. In addition, there are many factors affecting the efficiency of the endometrial biopsy. Failure to get samples that are adequate for histological examination is one of the problems associated with Pipelle sampling. The above mentioned contradictory conclusions by different researchers and lack of guidance to avoid inadequate sampling present the demand for further studies on the comparison of Pipelle biopsy and uterine curettage efficiency and accuracy.

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Comparison of Transvaginal Ultrasound, Saline Infusion Sonohysterography versus Diagnostic Hysteroscopy in Evaluation of Endometrial Cavity Pathology amongst Women with Abnormal Uterine Bleeding in Low Resource Setting

Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The incidence of submucosal fibroids and endometrial polyps was 17.5% and 15.0% via TVS, 47.5% and 20.0% via SIS and 52.5% and 20% via DH respectively. The overall sensitivity, specificity, Positive Predictive Value (PPV), Positive Predictive Value (NPV), and diagnostic accuracy of SIS were 92.1%, 83.3%, 96.9%, 62.5%, and 90.0% while TVS was 38.2%, 100%, 100%, 22.2%, and 47.5%. The sensitivity, specificity, PPV, and NPV of TVS in diagnosis of endometrial polyp were 75.0%, 100%, 100%, and 94.0%. SIS did better with a sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%. Conclusion: Our data suggests SIS had a higher diagnostic accuracy than TVS and showcased a comparable diagnostic accuracy to hysteroscopy. SIS is more suitable safe alternative technique for investigating AUB in pre/post-menopausal women in low resource setting where hysteroscopy is unavailable or unaffordable.

Can vaginal ultrasound replace diagnostic curettage in the detection of endometrial pathology in post-menopausal bleeding?

Background and objective: Post-menopausal bleeding due to endometrial abnormalities is a common diagnostic challenge facing the ultrasonogists and referring gynecologists. This study aimed to detect the validity of transvaginal ultrasound to detect endometrial pathologies and its sensitivity and specificity for determining endometrial carcinoma in women with postmenopausal bleeding. Methods: A diagnostic accuracy study of transvaginal ultrasound and diagnostic curettage was conducted for evaluation of endometrial pathology in the College of Medicine, Hawler Medical University from October2016to January 2018. The sample size included 55 women with post-menopausal vaginal bleeding. The ultrasound findings were compared with histopathological results of endometrial biopsy. Results: Out of 55 women, 49.09% had endometrial atrophy, 29.09% had endometrial hyperplasia, 16.36% had endometrial polyp, 3.64% had endometrial carcinoma, and 1.82% had hyperplasia with atypia according to histopathological findings. The sensitivity of ultrasound in detecting cancer was 66.7%, the specificity was 100%, the positive predictive value (PV) was 100%, and the negative predictive value was 98.1%. The total agreement rate was 98.2%. Conclusion: Transvaginal ultrasound is an excellent diagnostic tool to determine whether further investigation with histopathological examination of endometrial biopsy is necessary for postmenopausal vaginal bleeding.

Use of Transvaginal Ultrasound in the Evaluation of Endometrial Pathology in Women with a History of Tamoxifen Use and Postmenopausal Bleeding

Use of Transvaginal Ultrasound in the Evaluation of Endometrial Pathology in Women with a History of Tamoxifen Use and Postmenopausal Bleeding

Role of Chromohysteroscopy in Evaluation of Endometrial Pathology Using Methylene Blue Dye.

Chromohysteroscopy is expected to help in diagnosing subtle endometrial pathologies which could be missed on conventional hysteroscopy and also help in targeting biopsy from endometrium. To study staining pattern of endometrium in patients undergoing chromohysteroscopy andto evaluate and compare the histopathology of chromohysteroscopy-guided endometrial biopsy with conventional endometrial sampling. This was a cross-sectional study conducted during the period of 18 months in Department of Obstetrics and Gynaecology, ESI PGIMSR, New Delhi, India, from September 2016 to February 2018. Totally, 60 women with complaints of infertility, failed intrauterine insemination (IUI), recurrent spontaneous abortions (RSA), heavy menstrual bleeding (HMB), intermenstrual bleeding (IMB) and postmenopausal bleeding (PMB) meeting inclusion criteria were evaluated and enrolled in the study. In patients with normal looking endometrium on hysteroscopy, methylene blue dye was administered through the hysteroscopic inlet. Tissue samples were obtained from stained areas followed by blind endometrial sampling immediately. The results of chromohysteroscopy-guided biopsy from light- and dark-blue-stained areas and blind biopsy were compared. Mean age of the study group was 37 years, with mean BMI of 24 kg/m2. There were 24 cases of HMB, 9 of IMB, 7 of PMB, 15 of infertility, 2 of failed IUI and 3 with RSA. On chromohysteroscopy, 39(65%) cases showed light-stained endometrium (group I) and 21(35%) showed dark-stained endometrium (group II). Comparison was done between histopathology obtained through chromohysteroscopy and blind endometrial sampling. The diagnostic accuracy of chromohysteroscopy-guided endometrial biopsy in evaluation of endometrial pathology was 86.67% with sensitivity of 91.67%, specificity of 85.41%, PPV of 61.12% and NPV of 97.61% (P <0.001). Chromohysteroscopy was able to detect endometrial pathology which was missed on conventional hysteroscopy and detected more cases of endometrial pathology than blind endometrial sampling.

Practical Utility of Color Doppler Sonography in the Evaluation of Endometrial Pathology

The sonographic findings and corresponding pathology reports of 83 premenopausal and 55 postmenopausal women were retrospectively reviewed to evaluate the significance of color Doppler imaging in the evaluation of the endometrium. Premenopausal women had flow noted in the single malignancy case and in 16 of 21 (76%) polyps, with 7 polyps (33%) presenting as a vascular pedicle. In postmenopausal women, flow was seen in 3 of 5 (60%) malignancies and 5 of 9 (56%) polyps, with 2 polyps (22%) presenting as a vascular pedicle. Postmenopausal women with thin endometria had flow in 1 of 2 (50%) polyps, while those with thicker endometria had flow in 4 of 7 (56%) polyps and 3 of 5 (60%) malignancies. The data showed that color Doppler imaging was useful in detecting vascular pedicles in endometrial polyps, but it was not otherwise helpful as an independent predictor of malignancy.

M462 COMPARATIVE STUDY OF OUTPATIENT HYSTEROSCOPY VS TRANSVAGINAL SONOGRAPHY IN THE EVALUATION OF ENDOMETRIAL PATHOLOGY

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S679-S679 Poster presentations M462 COMPARATIVE STUDY OF OUTPATIENT HYSTEROSCOPY VS TRANSVAGINAL SONOGRAPHY IN THE EVALUATION OF ENDOMETRIAL PATHOLOGY I. Jawad, I. JawadSearch for more papers by this authorP. Athanasias, P. AthanasiasSearch for more papers by this authorN. Pisal, N. PisalSearch for more papers by this author I. Jawad, I. JawadSearch for more papers by this authorP. Athanasias, P. AthanasiasSearch for more papers by this authorN. Pisal, N. PisalSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61651-8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S679-S679 RelatedInformation

Diagnostic accuracy of liquid‐based endometrial cytology in the evaluation of endometrial pathology in postmenopausal women

The aim of this study was to compare liquid-based endometrial cytology with hysteroscopy and endometrial biopsy regarding its diagnostic accuracy in a series of postmenopausal women with abnormal uterine bleeding (AUB) or asymptomatic women with thickened endometrium assessed by transvaginal ultrasound as a screening procedure. Inclusion criteria were: menopausal status; the presence of AUB and/or thickened endometrium assessed by ultrasound (cut-off 4 mm); a normal Papanicolaou (Pap) smear; and no adnexal pathology at ultrasound. Exclusion criteria were: previous endometrial pathology; and previous operative hysteroscopy. Of 768 postmenopausal women referred to our general gynaecology clinics, 121 fulfilled the inclusion criteria and were recruited to the trial. Twenty-one refused to participate. Cytological sampling was carried out by brushing the uterine cavity using the Endoflower device with no cervical dilation and the vial was processed using a ThinPrep® 2000 automated slide processor. The slides were stained using a Pap method. In 98 cases with histological biopsies, endometrial cytology detected five cases of endometrial carcinoma, 10 of atypical hyperplasia and 47 of non-atypical hyperplasia; 36 cases were negative. In two cases cytology was inadequate because of uterine cervical stenosis. Taking atypical hyperplasia or worse as a positive test and outcome, the diagnostic accuracy of the endometrial cytology was 93.5%, with a sensitivity of 92% and specificity of 95%, a positive predictive value of 73% and a negative predictive value of 99%. All the carcinomas were detected by cytology. Only 42% of women with a positive diagnosis were symptomatic. The cytological sampling was well tolerated by all patients. No complication was registered. Liquid-based endometrial cytology can be considered an useful diagnostic method in the detection of endometrial pathology as a first-line approach, particularly if associated with transvaginal ultrasound.

A prospective comparison of transvaginal ultrasound, saline infusion sonohysterography, and diagnostic hysteroscopy in the evaluation of endometrial pathology

To compare the diagnostic performance of saline infusion sonohysterography (SIS), transvaginal ultrasound (TVS), and diagnostic hysteroscopy (DH) in the detection of endometrial lesions in symptomatic women. Prospective, comparative study. Obstetrics and Gynecology Department of a tertiary academic hospital. A total of 105 consecutive women presenting in an outpatient clinic with symptoms of menorrhagia, postmenopausal bleeding, and infertility. Each patient had TVS, SIS, and DH. The sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) for TVS, SIS, and DH were determined for the diagnosis of endometrial pathology. More specifically, the diagnostic performance of each of these three methods was compared after receiver operating characteristic analysis. By comparative analysis of the area under the curve, DH was found to have a significantly better diagnostic performance compared to SIS and TVS. In addition, after comparing the receiver operating characteristic curves, DH was found to be significantly more precise in the diagnosis of intracavitary masses than TVS and SIS. However, SIS was more accurate compared to TVS. Saline infusion sonohysterography appears to be more valuable than TVS in the diagnosis of intracavitary masses (both polyps and myomas).

Diagnostic hysteroscopy versus diagnostic curettage for evaluation of endometrial pathology in patients with abnormal uterine bleeding

Diagnostic hysteroscopy versus diagnostic curettage for evaluation of endometrial pathology in patients with abnormal uterine bleeding

Two-Dimensional Versus Three-Dimensional Ultrasound in the Evaluation of Endometrial Pathology:

The objective of this prospective study was to compare 2-dimensional (2D) and 3-dimensional (3D) images of endometrial pathology in premenopausal and postmenopausal patients. The 3D sonographic images were evaluated with respect to the contour and texture of the endometrium, endometrial to myometrial interface, and visible pathology in the 3D coronal view. Nine female patients referred for routine pelvic ultrasound exams were scanned transvaginally in both 2D and 3D, and common endometrial pathology including polyps, fluid collections, submucosal fibroids, and hyperplasia were identified. Only 44.4% of the pathology identified by 2D was visualized by 3D.

Saline infusion sonography (SIS) in the evaluation of endometrial pathology

International Journal of Gynecology & ObstetricsVolume 70, Issue S1 p. A38-A38 Ultrasound in gynecology Saline infusion sonography (SIS) in the evaluation of endometrial pathology A. Papanicolaou, A. PapanicolaouSearch for more papers by this authorI. Prapas, I. PrapasSearch for more papers by this authorG. Makedos, G. MakedosSearch for more papers by this authorC. Farmakis, C. FarmakisSearch for more papers by this authorG. Vlassis, G. VlassisSearch for more papers by this author A. Papanicolaou, A. PapanicolaouSearch for more papers by this authorI. Prapas, I. PrapasSearch for more papers by this authorG. Makedos, G. MakedosSearch for more papers by this authorC. Farmakis, C. FarmakisSearch for more papers by this authorG. Vlassis, G. VlassisSearch for more papers by this author First published: 09 December 2003 https://doi.org/10.1016/S0020-7292(00)82087-1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS12000Pages A38-A38 RelatedInformation