Aim: The purpose of this prospective study was to compare various diagnostic modalities in the evaluation of abnormal uterine bleeding (AUB) and judging the place of hysteroscopy (HYS) in obtaining the cause of AUB. This is done by correlating the findings on HYS and those found on dilation and curettage (D&C) and transvaginal sonography (TVS).
Materials and methods: This prospective study was performed in the Department of Obstetrics and Gynecology, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India. In this study, 60 cases of perimenopausal age group with AUB were chosen based on inclusion and exclusion criteria. The patients were subjected to routine investigations, TVS, HYS, and D&C in proliferative phase. The findings of the three were statistically analyzed by comparing with final histopathology diagnosis and test performances were calculated.
Results: Abnormal uterine bleeding was the commonest between 40 and 44 years (44%). Menorrhagia was the commonest presenting complaint (46%). Hysteroscopy was a better diagnostic tool than TVS and D&C for focal lesions. The diagnostic ability of HYS was higher, with sensitivity of 90.57% and specificity of 85.7% and diagnostic accuracy of 90% than TVS (sensitivity 79%, specificity 71.4%, and diagnostic accuracy 78.3%) in diagnosing intrauterine lesions in AUB.
Conclusion: This study reveals that HYS is superior in evaluating patients with AUB, when compared with D&C and ultrasonography (USG). Office hysteroscope, wherever available, must be used for evaluation of patients with AUB as an outpatient department (OPD) procedure along with clinical examination.
Clinical significance: There is rampant use of multiple diagnostic modalities in a single patient with AUB. So the need of the hour is to narrow down to a single diagnostic modality with maximum efficacy. There is a conflict between clinicians over use of TVS and HYS as a primary modality during evaluation of AUB. In this study, we attempted to find a solution.
Keywords: Abnormal uterine bleeding, Histopathology, Hysteroscopy, Perimenopausal women, Transvaginal sonography.
How to cite this article: Kaur R, Kedar KV. Evaluation of Abnormal Uterine Bleeding and Critical Analysis of Diagnostic Modalities. J South Asian Feder Menopause Soc 2016;4(2):75-80.
Source of support: Nil
Conflict of interest: None
Date of submission: 08 March 2016
Date of acceptance: 19 April 2016
Date of publication: July 2016