Intra-cavitary uterine pathology in women with abnormal uterine bleeding: a prospective study of 1220 women
Ultrasonography, endometrial cancer, polyps, leiomyoma, metrorrhagia
Published online: Mar 31 2015
Abstract
Objectives: Our primary aim was to assess how patients’ characteristics, bleeding pattern, sonographic endometrial thickness (ET) and additional features at unenhanced ultrasound examination (UTVS) and at fluid instillation sonography (FIS) contribute to the diagnosis of intracavitary uterine pathology in women presenting with abnormal uterine bleeding (AUB). We further aimed to report the prevalence of pathology in women presenting with AUB.
Methods: 1220 consecutive women presenting with AUB underwent UTVS, colour Doppler imaging (CDI) and FIS. Most women (n = 1042) had histological diagnosis. Results: Mean age was 50 years and 37% were postmenopausal. Of 1220 women 54% were normal, polyps were diagnosed in 26%, intracavitary fibroids in 11%, hyperplasia without atypia in 4% and cancer in 3%. All cancers were diagnosed in postmenopausal (7%) or perimenopausal (1%) women. ET had a low predictive value in premenopausal women (LR+ and LR- of 1.34 and 0.74, respectively), while FIS had a LR+ and LR- of 6.20 and 0.24, respectively. After menopause, ET outperformed all patient characteristics for the prediction of endometrial pathology (LR+ and LR- of 3.13 and 0.24). The corresponding LR+ and LR- were 10.85 and 0.71 for CDI and 8.23 and 0.26 for FIS.
Conclusion: About half of the women presenting to a bleeding clinic will have pathology. In premenopausal women, benign lesions are often the cause of AUB. For the prediction of intracavitary pathology ET is of little value in premenopausal women. CDI and FIS substantially improve the diagnostic accuracy.
T. Van den Bosch1, L. Ameye2, D. Van Schoubroeck1, T. Bourne2,3, D. Timmerman1,2
1Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
2KU Leuven Department of Development and Regeneration, Leuven, Belgium.
3Department of Obstetrics and Gynecology, Imperial College London, Hammersmith Campus, London, United Kingdom.
Correspondence at: T. Van den Bosch, MD, PhD, Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium. E-mail: thierryvandenbosch1901@gmail.com
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