Evaluation of endometrial pathology in women with postmenopausal bleeding by saline infusion sonography and hysteroscopy

Background: Postmenopausal bleeding (PMB) is a common problem representing 5% of all gynaecological outpatient attendance. Objective of this study was to determine diagnostic performance of saline infusion sonography and hysteroscopy for evaluation of endometrial lesions in postmenopausal bleeding.Methods: Being a prospective cross-sectional study, the present study was conducted on 46 postmenopausal women with bleeding, admitted to department of obstetrics and gynecology VMMC and Safdarjang Hospital, New Delhi, India. After TVS, all patients with ET >4 mm underwent SIS and then scheduled for hysteroscopy when there was no active bleeding. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to compare the diagnostic accuracy of SIS and hysteroscopy.Results: Most commonly found endometrial lesions were polyp (39.13%) and endometrial hyperplasia (28.26%) among our study population consisting of 46 postmenopausal women (mean age 56.72±6.6 years). Overall sensitivity rates were 86.84% for SIS and 97.37% for hysteroscopy, while the overall specificity rates were 50% for both SIS and hysteroscopy. Hysteroscopy had PPV and NPV of 90.24% and 80% respectively whereas PPV and NPV were 89.19% and 44.44% for SIS.Conclusions: As an easy to perform, safe and well tolerated procedure yielding high diagnostic accuracy, SIS seems to be comparable to hysteroscopy for endometrial evaluation.

Results of hysteroscopic management of endometrial pathology through laser diode in naval medical center: number of cases

Background: Hysteroscopy consists of an excellent technique for the diagnosis of uterine pathology, the diode laser for treatment has been included, which is energy in the form of a beam of light, monochromatic and coherent, equipped with a great capacity to cut tissues and vaporize them. Objective of this study was to know the result of the hysteroscopic treatment with diode laser, in patients of reproductive age with uterine pathology in the naval medical center of Mexico for a period of one year.Methods: A descriptive study was carried out in 8 patients, with abnormal uterine bleeding and uterine pathology, to know the result of the hysteroscopic treatment with diode laser, inclusion criteria were age of 18 to 40 years, uterine pathology, without previous treatments, exclusion criteria were pregnancy, medical treatment, does not accept the procedure, in a period of September 1, 2017 and September 1, 2018 at the Naval Medical Center of Mexico, the 45-watt 980 nm and 1470 wavelength diode laser console nm with 3fr extra flexible conical tip glass fibers.Results: The average age 29.9±8.5 years, without comorbidities; 60% had an initial diagnosis of endometrial thickening and abnormal uterine bleeding and 40% had a diagnosis of infertility, the most frequent pathology is an endometrial polyp, during the procedure none of the patients required analgesia or post-surgical sedation. The average bleeding was 24.44 ml.Conclusions: The hysteroscopic removal of uterine pathology with diode laser was performed without anesthesia, in an outpatient, feasible and safe way, the surgical time is reduced, with a follow-up of 12 months without recurrence.

A Study of Endometrial Pathology by Transvaginal Color Doppler Ultrasonography and its Correlation with Histopathology in Post-menopausal Women.

Objective: Endometrial carcinoma is the most common gynaecological malignancy. Approximately 80% of endomentrial carcinoma occur in post-menopausal women. Present study aimed to evaluate the role of transvaginal ultrasonography and colour flow imaging in diagnosing endometrial pathologies especially endometrial carcinoma and later its confirmation by histopathology. Methods: 38 women presenting with history of at least 6 months amenorrhoea followed by bleeding per vaginum were included in the study. Transvaginal colour Doppler (TVS) followed by fractional curettage was done in all cases and cervical biopsy was done in selected cases. Uterine size, endometrial thickness and blood flow indices (RI, PI) were measured. Analysis of data was done using ‘z’ test and ‘t’ test. Results: Out of 38 women maximum number of cases (39.47%) were between 50 – 55 years. Using 4 mm of endometrial thickness as cut off value for discriminating normal and abnormal endometrium, sensitivity, specificity, PPV and NPV were 94.12%, 50%, 95.12% and 50% respectively (p < 0.05). No case of endometrial carcinoma was detected when the endometrium was <4 mm, making the sensitivity as 100%, NPV 100%, specificity 13.33% and PPV 23.53%. Using RI = 0.81 as cut off value for discriminating benign and malignant endometrium, sensitivity was 62.5%, specificity 53.33%, PPV – 26.3% and NPV as 84.2%. Conclusion: Transvaginal sonographic (TVS) evaluation of endometrial thickness (ET) is a reliable method of screening women with post-menopausal bleeding. Conservative approach may be offered to women showing ET of less than 4 mm and high impedance to flow in uterine and endometrial vessels.

The Correlation between the Endometrial Cancer and Postmenopausal Uterine Bleeding / 고신대학교의과대학학술지

OBJECTIVES: To investigate correlation between risk factors of endometrial carcinoma and histopatholgic findings of endometrium. METHODS: We reviewed medical records of 148 postmenopausal women with abnormal uterine bleeding, who underwent endometrial biopsy from January 2009 to April 2010. Women who had hematologic disease, or had non-uterine pelvic diseases were excluded. Hormone therapy was performed in indicated subjects. Age, body mass index (BMI), associated diseases, endometrial thickness checked by transvaginal sonography, whether hormone therapy was used were reviewed according to endometrial histopathology. RESULTS: Mean age of the subjects was 58.9 +/- 8.4years old. Among the endometrial histopathologic findings, atrophic endometrium was the most common finding (32.7%), followed by hyperplastic endometrium (17.8%), endometrial carcinoma (10.4%), and endometrial polyp (9.2%). BMI was not correlation of the prevalence of endometrial carcinoma and endometrial hyperplasia. Mean endometrial thickness was 9.8 +/- 5.56 mm, while it was 14.0 +/- 5.89 mm in endometrial hyperplasia, and 16.0 +/- 6.56 mm in endometrial carcinoma. The prevalence of endometrial cancer was high in those whose endometrial thickness was more than 10 mm (P < 0.001). The prevalence of endometrial hyperplasia in those whose postmenopausal bleeding was related to hormone therapy was higher than of women in whom hormone therapy was not performed. However, there were no statistical significance. CONCLUSIONS: Postmenopausal bleeding must be considered as indicative of malignant disease until proven otherwise. Endometrial biopsy should be performed to exclude endometrial carcinoma in postmenopausal women whose endometrial thickness measured by transvaginal sonography is thick.

Endometrial pathologies in tamoxifen-treated breast cancer patients / 대한산부인과학회지

OBJECTIVE: Tamoxifen is a nonsteroidal hormone that functions as a selective estrogen-receptor (ER) modulator in breast tissue. It is the first-choice drug for the postoperative treatment of ER-positive breast cancer patients. However, tamoxifen, if administered for a prolonged duration, has estrogen-like effects on the uterus, leading to an increased risk for the development of endometrial diseases such as endometrial hyperplasia, endometrial polyp, and endometrial cancer. This study was designed to investigate the effects of tamoxifen treatment on endometrium in breast cancer patients. METHODS: Fifty-five tamoxifen-treated breast cancer patients visited an outpatient gynecology clinic. We analyzed the endometrial pathology with consideration to the duration of tamoxifen treatment the patient symptoms and the endometrial thickness, as measured by transvaginal ultrasonography. Endometrial polypectomy was performed to obtained polyps from women presenting with abnormal bleeding (17 polyps from postmenopausal women who had not been treated with tamoxifen and 14 from women who had been treated with this drug). To investigate the effects of tamoxifen treatment on the endometrial polyps, we performed immunohistochemical staining for ER, the progesterone receptor (PR), and Ki67 on the polyps obtained from both groups of women. RESULTS: In 29 (52.7%) of 55 tamoxifen-treated breast cancer patients, the endometrium was more than 10 mm thick, and in 19 (65.5%) of these patients, the abnormalities noted comprised 11 endometrial polyps, 5 endometrial carcinomas, 2 submucosal myomas, and 1 endometrial hyperplasia. The incidence of endometrial proliferation was significantly higher in patients who had been treated with tamoxifen for less than 1 year (P=0.037) than in those who had been treated for more than 1 year. Although the endometrial carcinomas, submucosal myomas, and endometrial hyperplasia were found in the patients who had been treated for more than 1 year, this result was not statistically significantwhen compared with the other group. As compared to the endometrial polyps obtained from women who had not received tamoxifen treatment, those obtained from patients who had received the treatment exhibited significantly lower levels of ER expression (P=0.000) in the glands and increased levels of PR (P=0.031) and Ki-67 expression (P=0.000) in the stroma. CONCLUSIONS: During tamoxifen treatment for breast cancer, the endometrial pathology should be investigated if transvaginal ultrasonography reveals the tissue to be more than 10 mm thick. Although tamoxifen has significant effects on the expression of hormone receptors, the mechanism underlying the development of endometrial polyps does not appear to be mediated by the ER.