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Diagnostic Accuracy of Saline Hysterosonography in Detecting Endometrial Hyperplasia in Patients with Postmenopausal Bleeding

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Diagnostic Accuracy of Saline Hysterosonography in Detecting Endometrial Hyperplasia in Patients with Postmenopausal Bleeding Original Article DIAGNOSTIC ACCURACY OF SALINE HYSTEROSONOGRAPHY IN DETECTING ENDOMETRIAL HYPERPLASIA IN PATIENTS WITH POSTMENOPAUSAL BLEEDING Beenish Yousufa, Hira Ambreenb, Tahira Mariamc , Abdul Raoufd , Ambreen Yaseena, Rabia Aslamb, Muhammad Ahsane aWomen Medical officer, Department of Obstetrics & Gynecology, Government General Hospital, Faisalabad. bConsultant Gynecologist DHQ Hospital, Chiniot. cWomen Medical officer THQ Hospital Chichawatni. dAssistant Professor, Department of Radiology, Faisalabad Medical University, Faisalabad. eMedical Officer, Department of Pediatrics, Government General Hospital, Faisalabad. ABSTRACT: BACKGROUND & OBJECTIVE: Saline hysterosonography is a simple and cost-effective method with high sensitivity to detect uterine abnormalities causing postmenopausal bleeding. The objective of this study was to evaluate the diagnostic accuracy of saline hysterosonography in detecting endometrial hyperplasia in women with postmenopausal bleeding by taking histopathology as a gold standard. METHODOLOGY: A hundred and twenty (120) cases were enrolled from the outpatient and inpatient department of obstetrics and gynecology. Proper history and relevant examination of the patient was done. Then preparations were made for the procedure. The patient was counseled and the technique explained to her. Then Foley catheter no 12 was passed in cervix and sonography was done while instilling normal saline through a cervical catheter and scan pictures were frozen and results were given by expert gynecologist of Allied Hospital, Faisalabad. Histopathology specimen was sent to the pathology lab. RESULTS: Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of saline hysterosonography in detecting endometrial hyperplasia was recorded as 96.15%,91,49%,75.76%,98.85%, and 92.5% respectively. CONCLUSION: Saline hysterosonography has high sensitivity to detect uterine hyperplasia. It can be used as a cost effective alternative to hysteroscopy in many units in Pakistan. KEYWORDS: Saline hysterosonography, Endometrial hyperplasia, Postmenopausal bleeding. doi: https://doi.org/10.37723/jumdc.v11i2.304 How to cite this: Yousuf B, Ambreen H, Mariam T, Raouf A, Yaseen A, Aslam R, Ahsan M. DIAGNOSTIC ACCURACY OF SALINE HYSTEROSONOGRAPHY IN DETECTING ENDOMETRIAL HYPERPLASIA IN PATIENTS WITH POST MENOPAUSAL BLEEDING. jumdc. 2020;11(2):1-8. doi: https://doi.org/10.37723/jumdc.v11i2.304 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. JUMDC Vol. 11, Issue 2, April-June 2020 1 YOUSUF B., AMBREEN H., et al. SCSH IN ENDOMETRIAL HYPERPLASIA INTRODUCTION: Corresponding Author: Dr. Muhammad Ahsan Postmenopausal bleeding (PMB) occurs in Medical Officer, Govt General Hospital, Faisalabad. approximately 3% of postmenopausal women Email: [email protected] [1]. Abnormal bleeding is the cause behind 33% of all admissions to gynecology center and 69% [2] c a n b e r e p l a c e d b y s a l i n e c o n t r a s t among postmenopausal women . Excessive [10] bleeding occurring outside of regular menstrual sonohysterography (SCSH) . Saline contrast cycle in which two-third of all hysterectomies is s o n o h y s t e r o g r a p h y o r s a l i n e accounted for is characterized as abnormal hysterosonography (SCHS) can be considered [3] as a primary diagnostic method in the detection uterine bleeding . Simple atrophic vaginitis to [11] endometrial carcinoma in postmenopausal of uterine cavity abnormalities . It seems that women is the reason for abnormal bleeding. The SCSH is a noninvasive, cost-effective, and feasible technique and less painful for patients most common lesions resulting in abnormal [ 1 2 ] uterine bleeding are endometrial polyps, t h a n h y s t e r o s c o p y . S a l i n e uterine fibroids, endometrial hyperplasia [4]. hysterosonography has become a valuable Surgical treatment may be required for them. diagnostic modality in gynecology over the last While medical treatment is required for three decades and is now commonly used for a [2] thorough evaluation of the lesions in the dysfunctional causes . [13, 14] The chance of having endometrial carcinoma for endometrial cavity . patients with PMB is 10–15% [5]. For women The rationale of this study is to introduce a over the age of 40 with abnormal uterine simple and noninvasive investigation tool to bleeding, the clinician's vital task is to exclude detect endometrial abnormalities in patients endometrial carcinoma [6]. The excessive with postmenopausal bleeding and its effect on p r o l i f e ra t i o n o f n o r m a l c e l l s c a n b e clinical administration. The objective of this characterized by the term endometrial cross-sectional (validation) study was to assess hyperplasia. It can further be ordered into three t h e d i a g n o s t i c a c c u r a c y o f s a l i n e types: simple, complex, and atypical. The hysterosonography in detecting endometrial development rate of malignancy is less than 3% hyperplasia in women with postmenopausal for both simple and complex types due to bleeding by taking histopathology as a gold p r e m a l i g n a n t c o n d i t i o n s . I n va r i o u s standard. arrangements, the risk of underlying malignancy has demonstrated to be higher than METHODOLOGY: anticipated. So it is very important to detect it as early as possible to make decisions regarding The study has been approved by the ethical surgery if the patient is high risk or follow up in review committee of Faisalabad Medical low-risk cases [7]. In a previous study, the University, Faisalabad. Postmenopausal prevalence of endometrial hyperplasia was bleeding was diagnosed when a woman after 26%[1]. menopause, presented with complaints of per- For the analysis of uterine abnormality leading vaginal bleeding that may range from spotting to postmenopausal bleeding, an assortment of to a massive pool of blood. Menopause is tools can be utilized. Among these, for the defined as the last menstrual period after a evaluation of abnormalities of the uterine minimum of 1-year amenorrhea and her age cavity, hysteroscopy is considered the gold >50. standard [8]. With saline hysterosonography endometrial In postmenopausal women, transvaginal hyperplasia, typically appear as diffuse sonography (TVS) is an effective screening test t h i c ke n i n g o f t h e e n d o m e t r i u m w i t h for the evaluation of abnormal uterine bleeding endometrial thickness 5mm to 8mm. On caused by endometrial atrophy [9]. But in the histopathology of the biopsy specimen, figure of thickened and inhomogeneous endometrial hyperplasia is characterized by endometrium, TVS is presented as low mild to marked increase in several glands of specificity and limited diagnostic tests which different sizes and unpredictable shapes with 2 JUMDC Vol. 11, Issue 2, April-June 2020 YOUSUF B., AMBREEN H., et al. SCSH IN ENDOMETRIAL HYPERPLASIA cystic dilatation, with mild to a marked was recorded and informed consent was taken escalation in gland to stroma ratio and from patients or their guardians to incorporate glandular epithelial cells may or may not have the information in research work. cytologic atypia as defined by loss of polarity, After receiving patients in the outpatient vesicular nuclei, and prominent nucleoli. department or after admission in ward, proper Sensitivity is the proportion of true positives out history and relevant examination of the patient of all those who truly have the endometrial were done. Then preparation was made for the hyperplasia. Specificity is the proportion of true procedure. The patient was counseled and the negatives out of all those who truly don't have technique explained to her. Foley's catheter no the endometrial hyperplasia. Positive predictive 12 was passed in cervix and sonography was value is the proportion of true positives out of all done while instilling normal saline through a t h o s e w h o a r e p o s i t i v e o n s a l i n e cervical catheter and scan pictures were frozen hysterosonography. Negative predictive value and results were given by expert gynecologist of is the proportion of true negatives out of all Allied Hospital, Faisalabad. Regarding t h o s e w h o a r e n e g a t i v e o n s a l i n e histopathology specimen, it was sent to the hysterosonography. True positives (TP) are Pathology laboratory in Faisalabad Medical those individuals who are positive on saline University where results were given by expert h y s t e r o s o n o g r a p h y a s w e l l a s o n pathologist. histopathology. True negatives (TN) are those All the data were analyzed by SPSS version-23. individuals who are negative on saline Quantitative variables like age endometrial hysterosonography as well as histopathology. thickness were presented by the mean and False positives (FP) are those individuals who standard deviation. Frequency and percentage are positive on saline hysterosonography but were presented for qualitative variables like negative on histopathology. False negatives true positives. Sensitivity, specificity, positive (FN) are those individuals who are negative on predictive value, negative predictive value, and saline hysterosonography but positive on diagnostic preciseness were determined by histopathology. building two into two tables by taking It was conducted in the Department of histopathology as the highest level standard. obstetrics and gynecology, Allied Hospital, Faisalabad after 6 months of synopsis approval.
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