Iranian Society of Gynecology Oncology

Authors

Obstetrics and Gynecology Department, Medicine Faculty, Iran University of Medical Sciences, Tehran, Iran

Abstract

Aims: Since there is no consensus on the best diagnostic method for perimenopausal women with abnormal uterine bleeding. The aim of this study was to investigate the association between endometrial thickness in transvaginal ultrasound and the results of Pipelle endometrial sampling in perimenopausal women with abnormal uterine bleeding.
Materials and Methods: In this cross-sectional descriptive study, all perimenopausal women with abnormal uterine bleeding who referred to Rasoul Akram and Akbarabadi Hospitals, Tehran, Iran in 2016 and 2017 were considered. The current study was carried out on a corpus of 68 perimenopausal women with abnormal uterine bleeding. All these patients underwent a transvaginal ultrasound conducted by an operator. Afterward, all of them had a Pipelle endometrial sampling performed by a gynecologist. The current study was carried out on a corpus of 68 perimenopausal women with abnormal uterine bleeding. A chi-square, Mann Whitney, and Kruskal Wallis tests were used. The obtained data were analyzed using SPSS 22.
Findings: A statistical mean endometrial thickness in patients with benign diagnoses was 7.55±2.72mm and it was 15.57±2.99mm in patients with malignant diagnoses which indicated no statistically significant difference (p<0.001). Evaluating a receiver operating characteristic curve (ROC) demonstrated that the cut-off point of endometrial thickness was 10.50 with a sensitivity of 85% and a specificity of 85%.
Conclusion: Determining the cut-off point of 10.50mm for endometrial thickness using transvaginal ultrasound in perimenopausal women is a suitable, non-invasive method, the results of which can predict the results of Pipelle endometrial sampling well.

Keywords

  1. Word B, Gravlee LC, Wideman GL. The fallacy of simple uterine curettage. Obstet Gynecol. 1958;12(6):642-8.
  2. Grimes DA. Diagnostic dilation and curettage: A reappraisal. Am J Obstet Gynecol. 1982;142(1):1-6. [DOI:10.1016/S0002-9378(16)32276-1]
  3. Stock RJ, Kanbour A. Prehysterectomy curettage. Obstet Gynecol. 1975;45(5):537-41.
  4. Stovall TG, Solomon SK, Ling FW. Endometrial sampling prior to hysterectomy. Obstet Gynecol. 1989;73(3 Pt 1):405-9.
  5. Gimpelson RJ, Rappold HO. A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage, a review of 276 cases. Am J Obstet Gynecol. 1988;158(3 Pt 1):489-92. [DOI:10.1016/0002-9378(88)90011-7]
  6. Mencaglia L, Perino A, Hamou J. Hysteroscopy in perimenopausal and postmenopausal women with abnormal uterine bleeding. J Reprod Med. 1987;32(8):577-82.
  7. De Jong P, Doel F, Falconer A. Outpatient diagnostic hysteroscopy. Br J Obstet Gynaecol. 1990;97(4):299-303. [DOI:10.1111/j.1471-0528.1990.tb01805.x] [PMID]
  8. Walton SM, Macphail S. The value of hysteroscopy in postmenopausal and perimenopausal bleeding. J Obstet Gynaecol. 1988;8(4):332-6. [DOI:10.3109/01443618809008815]
  9. Downes E, Al-Azzawi F. The predictive value of outpatient hysteroscopy in a menopause clinic. Br J Obstet Gynaecol. 1993;100(12):1148-9. [DOI:10.1111/j.1471-0528.1993.tb15187.x] [PMID]
  10. Taipale P, Tarjanne H, Heinonen UM. The diagnostic value of transvaginal sonography in the diagnosis of endometrial malignancy in women with peri- and postmenopausal bleeding. Acta Obstet Gynaecol Scand. 1994;73(10):819-23. [DOI:10.3109/00016349409072512] [PMID]
  11. Cicinelli E, Romano F, Anastasio PS, Blasi N, Parisi C, Galantino P. Transabdominal sonohysterography, transvaginal sonography, and hysteroscopy in the evaluation of submucous myomas. Obstet Gynecol. 1995;85(1):42-7. [DOI:10.1016/0029-7844(94)00298-R]
  12. Georgiev DB, Chernev T, Netzov V, Dimova DN. Preoperative sonographic evaluation of patients with endometrial carcinoma. Int J Gynaecol Obstet. 1994;47(2):147-50. [DOI:10.1016/0020-7292(94)90355-7]
  13. Dørum A, Kristensen GB, Langebrekke A, Sørnes T, Skaar O. Evaluation of endometrial thickness measured by endovaginal ultrasound in women with postmenopausal bleeding. Acta Obstet Gynecol Scand. 1993;72(2):116-9. [DOI:10.3109/00016349309023423] [PMID]
  14. Fothergill DJ, Brown VA, Hill AS. Histological sampling of the endometrium -- a comparison between formal curettage and the pipelle sampler. Br J Obstet Gynaecol. 1992;99(9):779-80. [DOI:10.1111/j.1471-0528.1992.tb13887.x] [PMID]
  15. Eddowes HA, Read MD, Codling BW. Pipelle: A more acceptable technique for outpatient endometrial biopsy. Br J Obstet Gynaecol. 1990;97(10):961-2. [DOI:10.1111/j.1471-0528.1990.tb02458.x] [PMID]
  16. Stovall TG, Ling FW, Morgan PL. A prospective, randomized comparison of the Pipelle endometrial sampling device with the Novak curette. Am J Obstet Gynecol. 1991;165(5 Pt 1):1287-90. [DOI:10.1016/0002-9378(91)90351-Q]
  17. Tahir MM, Bigrigg MA, Browning JJ, Brookes ST, Smith PA. A randomised controlled trial comparing transvaginal ultrasound, outpatient hysteroscopy and endometrial biopsy with inpatient hysteroscopy and curettage. Br J Obstet Gynaecol. 1999;106(12):1259-64. [DOI:10.1111/j.1471-0528.1999.tb08179.x] [PMID]
  18. Reid PC, Brown VA, Fothergill DJ. Outpatient investigation of postmenopausal bleeding. Br J Obstet Gynaecol. 1993;100(5):498. [DOI:10.1111/j.1471-0528.1993.tb15282.x] [PMID]
  19. Ferry J, Farnsworth A, Webster M, Wren B. The efficacy of the pipelle endometrial biopsy in detecting endometrial carcinoma. Aust N Z J Obstet Gynaecol. 1993;33(1):76-8. [DOI:10.1111/j.1479-828X.1993.tb02060.x] [PMID]
  20. Mencaglia L, Perino A. Diagnostic hysteroscopy today. Acta Eur Fertil. 1986;17(6):431-9.
  21. Fleischer AC, Mendelson EB, Böhm-Vélez M, Entman SS. Transvaginal and transabdominal sonography of the endometrium. Semin Ultrasound CT MR. 1988;9(2):81-101.
  22. Fedele L, Bianchi S, Dorta M, Brioschi D, Zanotti F, Vercellini P. Transvaginal ultrasonography versus hysteroscopy in the diagnosis of uterine submucous myomas. Obstet Gynecol. 1991;77(5):745-8.
  23. Rose PG. Endometrial carcinoma. N Engl J Med. 1996;335:640-9. [DOI:10.1056/NEJM199608293350907] [PMID]
  24. Lidor A, Ismajovich B, Confino E, David MP. Histopathological findings in 226 women with post menopausal uterine bleeding. Acta Obstet Gynecol Scand. 1986;65(1):41-3. [DOI:10.3109/00016348609158227] [PMID]
  25. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30. [DOI:10.3322/caac.21442] [PMID]
  26. van den Bosch T, Vandendael A, van Schoubroeck D, Wranz PA, Lombard CJ. Combining vaginal ultrasonography and office endometrial sampling in the diagnosis of endometrial disease in postmenopausal women. Obstet Gynecol. 1995;85(3):349-52. [DOI:10.1016/0029-7844(94)00421-9]
  27. Karlsson B, Granberg S, Wikland M, Ylöstalo P, Torvid K, Marsal K, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding -- a Nordic multicenter study. Am J Obstet Gynecol. 1995;172(5):1488-94. [DOI:10.1016/0002-9378(95)90483-2]
  28. Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. Jama. 1998;280(17):1510-7. [DOI:10.1001/jama.280.17.1510] [PMID]
  29. American College of Obstetricians and Gynecologists. Guidelines for women's health care. Washington: American College of Obstetricians and Gynecologists; 1996.
  30. Guido RS, Kanbour-Shakir A, Rulin MC, Christopherson WA. Pipelle endometrial sampling, sensitivity in the detection of endometrial cancer. J Reprod Med. 1995;40(8):553-5.
  31. Ferrazzi E, Torri V, Trio D, Zannoni E, Filiberto S, Dordoni D. Sonographic endometrial thickness: A useful test to predict atrophy in patients with postmenopausal bleeding an Italian multicenter study. Ultrasound Obstet Gynecol. 1996;7(5):315-21. [DOI:10.1046/j.1469-0705.1996.07050315.x] [PMID]
  32. Malinova M, Pehlivanov B. Transvaginal sonography and endometrial thickness in patients with postmenopausal uterine bleeding. Eur J Obstet Gynecol Reprod Biol. 1995;58(2):161-5. [DOI:10.1016/0028-2243(95)80017-M]
  33. Weber AM, Belinson JL, Bradley LD, Piedmonte MR. Vaginal ultrasonography versus endometrial biopsy in women with postmenopausal bleeding. Am J Obstet Gynecol. 1997;177(4):924-9. [DOI:10.1016/S0002-9378(97)70295-3]
  34. Ben-Baruch G, Seidman DS, Schiff E, Moran O, Menczer J. Outpatient endometrial sampling with the Pipelle curette. Gynecol Obstet Invest. 1994;37(4):260-2. [DOI:10.1159/000292573] [PMID]
  35. Shobeiri E, Kolivand S. Evaluation of the relationship between endometrial thickness measured by transvaginal ultrasound and response rate to the treatment with single-dose intramuscular methotrexate in the women with ectopic pregnancy. Sci J Kurdistan Univ Med Sci. 2014;19(3):77-83. [Persian]
  36. Getpook C, Wattanakumtornkul S. Endometrial thickness screening in premenopausal women with abnormal uterine bleeding. J Obstet Gynaecol Res. 2006;32(6):588-92. [DOI:10.1111/j.1447-0756.2006.00455.x] [PMID]
  37. Goldstein SR, Zeltser I, Horan CK, Snyder JR, Schwartz LB. Ultrasonography- based triage for perimenopausal patients with abnormal uterine bleeding. Am J Obstet Gynecol. 1997;177(1):102-8. [DOI:10.1016/S0002-9378(97)70446-0]
  38. Kamel HS, Darwish AM, Mohamed SA. Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps. Acta Obstet Gynecol Scand. 2000;79(1):60-4. https://doi.org/10.1080/j.1600-0412.2000.079001060.x [DOI:10.1034/j.1600-0412.2000.079001060.x]
  39. Vercellini P, Cortesi I, Oldani S, Moschetta M, de Giorgi O, Crosignani PG. The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia. Hum Reprod. 1997;12(8):1768-71. [DOI:10.1093/humrep/12.8.1768] [PMID]
  40. Vahid Dastjerdi M, Alavi Tabari N, Asgari Z, Beygi A. The relationship of endometrial thickness detected by transvaginal sonography with the results of endometrial biopsy & hysteroscopic directed biopsy in post menopausal bleeding. Tehran Univ Med J. 2008;65(11):28-32. [Persian]
  41. Dueholm M, Jensen ML, Laursen H, Kracht P. Can the endometrial thickness as measured by trans-vaginal sonography be used to exclude polyps or hyperplasia in pre-menopausal patients with abnormal uterine bleeding?. Acta Obstet Gynecol Scand. 2001;80(7):645-51. https://doi.org/10.1080/j.1600-0412.2001.800710.x [DOI:10.1034/j.1600-0412.2001.800710.x]
  42. Kim MJ, Kim JJ, Kim SM. Endometrial evaluation with transvaginal ultrasonography for the screening of endometrial hyperplasia or cancer in premenopausal and perimenopausal women. Obstet Gynecol Sci. 2016;59(3):192-200. [DOI:10.5468/ogs.2016.59.3.192] [PMID]
  43. Pyari JS, Rekha S, Srivastava P, Goel M, Pandey M. A comparative diagnostic evaluation of hysteroscopy, transvaginal ultrasonography and histopathological examination in cases of abnormal uterine bleeding. J Obstet Gynecol India. 2006;56(3):240-3.