Concordance Between Hysteroscopy, Ultrasound, and Pathological Findings in Perimenopausal Patients with Abnormal Uterine Bleeding
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Abstract
OBJECTIVE: To determine the concordance between hysteroscopic, ultrasonographic, and pathological findings, estimating the sensitivity and specificity of hysteroscopy and ultrasound with the histopathological study in perimenopausal patients diagnosed with abnormal uterine bleeding during the period February 2024-November 2024 at the Veracruz High Specialty Hospital
MATERIAL AND METHODS: Records of perimenopausal patients with abnormal uterine bleeding who underwent an ultrasound and hysteroscopic evaluation at the Veracruz Regional High Specialty Hospital were reviewed. The Kappa test was applied for concordance of qualitative variables, the sensitivity and specificity of hysteroscopy and ultrasound with the histopathological study was estimated. Finally, the results will be grouped into pie charts and bar graphs.
RESULTS: we recorded data of 70 patients and we analiced a sensitivity of 0.93 (95%CI:) and specificity of 0.94 (95%CI:) were recorded for hysteroscopy, for ultrasonography a sensitivity of 0.93 (95%CI) and specificity of 0.93 (95%CI:). The concordance between histopathology and hysteroscopy was 0.8573724387 (KAPPA VALUE) (95%CI 1- 0.624)
CONCLUSIONS: Hysteroscopy in the diagnosis of the causes of abnormal uterine bleeding in perimenopausal women showed a remarkable concordance with the histopathological findings. The sensitivity and specificity values highlight hysteroscopy as a reliable and superior method compared to ultrasonography. The combination of both techniques can improve the diagnosis and management of these patients.
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References
I. Vitale SG, Buzzaccarini G, Riemma G, Pacheco LA, Di Spiezio Sardo A, Carugno J, et al. Endometrial biopsy: Indications, techniques and recommendations. An evidence-based guideline for clinical practice. Vol. 52, Journal of Gynecology Obstetrics and Human Reproduction. Elsevier Masson s.r.l.; 2023.
II. Vitale SG, Buzzaccarini G, Riemma G, Pacheco LA, Di Spiezio Sardo A, Carugno J, et al. Endometrial biopsy: Indications, techniques and recommendations. An evidence-based guideline for clinical practice. Vol. 52, Journal of Gynecology Obstetrics and Human Reproduction. Elsevier Masson s.r.l.; 2023.
III. Piatek S, Warzecha D, Kisielewski F, Szymusik I, Panek G, Wielgos M. Pipelle biopsy and dilation and curettage in clinical practice: are factors affecting their effectiveness the same? Journal of Obstetrics and Gynaecology Research. on March 1, 2019; 45(3):645–51.
IV. Lasmar RB, Dias R, Barrozo PRM, Oliveira MAP, da Silva Freire Coutinho E, da Rosa DB. Prevalence of hysteroscopic findings and histologic diagnoses in patients with abnormal uterine bleeding. Fertil Steril. June 2008; 89(6):1803–7.
V. Kaveh M, Sadegi K, Salarzaei M, Parooei F. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography, and hysteroscopy in evaluating the endometrial polyps in women with abnormal uterine bleeding: A systematic review and meta-analysis. Wideochirurgia I Inne Techniki Maloinwazyjne. 2020; 15(3):403–15.
VI. Ryu JA, Kim B, Lee J, Kim S, Lee SH. Comparison of Transvaginal Ultrasonography with Hysterosonography as a Screening Method in Patients with Abnormal Uterine Bleeding A. Vol. 5, Korean J Radiol. 2004.
VII. Hysteroscopy And Targeted Biopsy In The Study Of Thickening C DE, Socías MT, Vargas RS, Costoya AA, Monje BR, Teresa Haye MM. 99 CORRELATION OF HYSTEROSCOPY AND TARGETED BIOPSY Original Papers.
VIII. Munro MG, Critchley HOD, Fraser IS, Haththotuwa R, Kriplani A, Bahamondes L, et al. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. International Journal of Gynecology and Obstetrics. December 1, 2018; 143(3):393–408.
IX. Vitale SG, Haimovich S, Laganà AS, Alonso L, Di Spiezio Sardo A, Carugno J. Endometrial polyps. An evidence-based diagnosis and management guide. Vol. 260, European Journal of Obstetrics and Gynecology and Reproductive Biology. Elsevier Ireland Ltd; 2021. p. 70–7.
X. Epstein E, Fischerova D, Valentin L, Testa AC, Franchi D, Sladkevicius P, et al. Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study. Ultrasound in Obstetrics and Gynecology. June 1, 2018; 51(6):818–28.
XI. GRAZIANO1 GLMIPDCMKBERM. Diagnostic findings in adenomyosis: a pictorial review on the major concerns. Italy; 2015.
XII. Valentine LN, Bradley LD. Hysteroscopy for Abnormal Uterine Bleeding and Fibroids [Internet]. Cleveland, Ohio; 2017 Jun. Available in: www.clinicalobgyn.com
XIII. Casadio P, Youssef AM, Spagnolo E, Rizzo MA, Talamo MR, De Angelis D, et al. Should the myometrial free margin still be considered a limiting factor for hysteroscopic resection of submucous fibroids? A possible answer to an old question. Fertil Steril. 2011; 95(5).
XIV. Clark J, Chb MB, Stevenson H. Endometrial Polyps and Abnormal Uterine Bleeding (AUB-P)-What is the relationship; how are they diagnosed and how are they treated?
XV. Giampaolino P, Della Corte L, Di Filippo C, Mercorio A, Vitale SG, Bifulco G. Office hysteroscopy in the management of women with postmenopausal bleeding. Vol. 23, Climacteric. Taylor and Francis Ltd; 2020. p. 369–75.
XVI. Prasad A, Kumar A. Role of hysteroscopy in abnormal uterine bleeding and its histopathological correlation. International Journal of Clinical Obstetrics and Gynaecology [Internet]. 2017; 30(2):30–3. Available in:
www.gynaecologyjournal.com
XVII. Piatek S, Warzecha D, Kisielewski F, Szymusik I, Panek G, Wielgos M. Pipelle biopsy and dilation and curettage in clinical practice: are factors affecting their effectiveness the same? Journal of Obstetrics and Gynaecology Research. on March 1, 2019; 45(3):645–51.
XVIII. Lasmar RB, Dias R, Barrozo PRM, Oliveira MAP, da Silva Freire Coutinho E, da Rosa DB. Prevalence of hysteroscopic findings and histologic diagnoses in patients with abnormal uterine bleeding. Fertil Steril. June 2008; 89(6):1803–7.
XIX. Louis F, Lulla CP. Hysteroscopy is Superior to 3D Ultrasound in Gynecological Diagnosis. Journal of Obstetrics and Gynecology of India. December 1, 2020; 70(6):447–61.
XX. Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Evaluation of the uterine cavity with magnetic resonance imaging, transvaginal sonography, hysterosonographic examination, and diagnostic hysteroscopy. 2001.
XXI. Amy L García M. The role of hysteroscopy in diagnosing endometrial cancer. OBG Manag. March 2020; 32(3):36–46.
XXII. Matsumoto Y, Yamaguchi K, Maruyama M, Sone K, Mori-Uchino M, Hirota Y, et al. Characteristic hysteroscopy appearance considerations for detecting uterine endometrial malignancies. Journal of Obstetrics and Gynaecology Research. April 1, 2024; 50(4):566–71.
XXIII. Di Spiezio Sardo A, Calagna G, Santangelo F, Zizolfi B, Tanos V, Perino A, et al. The Role of Hysteroscopy in the Diagnosis and Treatment of Adenomyosis. BioMed Research International. 2017;
XXIV. S. TEKIN1 AOESCBAC. Histological assessment of endometrial polyps resected by hysteroscopy. European Review for Medical and Pharmacological Sciences. 2024; 28:3241–50.
XXV. Vitale SG, Riemma G, Carugno J, Chiofalo B, Vilos GA, Cianci S, et al. Hysteroscopy in the management of endometrial hyperplasia and cancer in reproductive aged women: new developments and current perspectives. Vol. 9, Translational Cancer Research. AME Publishing Company; 2020. p. 7767–77.
XXVI. Di Spiezio Sardo A, De Angelis MC, Della Corte L, Carugno J, Zizolfi B, Guadagno E, et al. Should endometrial biopsy under direct hysteroscopic visualization using the grasp technique become the new gold standard for the preoperative evaluation of the patient with endometrial cancer? Gynecol Oncol. August 1, 2020; 158(2):347–53.
XXVII. by Franciscis P, Riemma G, Schiattarella A, Cobellis L, Guadagno M, Vitale SG, et al. Concordance between the hysteroscopic diagnosis of endometrial hyperplasia and histopathological examination. Diagnostics. December 1, 2019; 9(4).
XXVIII. Suárez-Enríquez J, Pérez-López JDC, Martínez-Hernández CM. Concordance between hysteroscopy and histopathology in patients with abnormal uterine bleeding. Healthcare Horizon. on August 22, 2018; 18(1).
XXIX. Rizvi G, Pandey H, Pant H, Chufal S, Pant P. Histopathological correlation of adenomyosis and leiomyoma in hysterectomy specimens as the cause of abnormal uterine bleeding in women in different age groups in the Kumaon region: A retroprospective study. J Midlife Health. 2013; 4(1):27.
XXX. Nijkang NP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. Vol. 7, SAGE Open Medicine. SAGE Publications Ltd; 2019.
XXXI. Wong CLH, So PL. Prevalence and risk factors for malignancy in hysteroscopy-resected endometrial polyps. International Journal of Gynecology and Obstetrics. on December 1, 2021; 155(3):433–41.