THE ROLE OF ENDOMETRIAL VOLUME IN THE PREDICTION OF ENDOMETRIAL HYPERPLASIA

Abstract

Abnormal Uterine Bleeding (AUB) is defined as bleeding from the uterine corpus that is abnormal in volume, regularity, and/or timing. AUB is one of the most common presenting complaints that affects 10-30% of reproductive-aged women and constitutes about one-third of all outpatient gynecological visits. Causes of AUB include polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory disorders; endometrium; iatrogenic; and not classified. Diagnosis of AUB depends upon detailed history and thorough examination in addition to investigations in the form of transvaginal ultrasound with special focus on the measurement of the endometrial thickness, and endometrial sampling better obtained with hysteroscopic guidance. Ultrasonography is non-invasive and is currently one of the most frequently used diagnostic techniques for evaluating the endometrium. Thus, ultrasonography has become an important supplement to a routine gynecological examination, and clinical procedures are often based on the results of this examination. However, using this technique to measure the thickness of the endometrium itself is not sufficient. 3D Transvaginal ultrasound enables an assessment of uterine and endometrial volume. This technique created the potential to distinguish malignant changes from non-malignant changes. This is one of the most advanced diagnostic methods used in the diagnostic process of female genitals. The purpose of this study was to assess the accuracy of 3D Trans-vaginal Ultrasound in diagnosis of endometrial endometrial hyperplasia with endometrial volume measurment in women with premenopausal abnormal uterine bleeding. The current study is an accuracy of diagnostic test which was conducted in Ain Shams University Maternity Hospital, cases were recruited from the outpatient gynaecological clinic and 75 perimenopausal women were included in the study. All cases presented by abnormal uterine bleeding. The study was conducted between May 2014 & December 2014. Detailed history was obtained and full examination was done for every patient. In addition, transvaginal ultrasound was done were the endometrial volume was measured then All patients were then submitted to endometrial curettage. Also, it turned out that among factors coinciding with these endometrial pathologies, the biggest importance was for the BMI and the presence of a family history of uterine malignancy. However, increased parity was not a protective factor against the disease. In the current study the difference between patients with benign endometrium, endometrial hyperplasia and endometrial carcinoma as regarding age were (49.6±2.6, 51.7±2.8 AND 51.7±2.7) respectively as in table (4). These results are statistically significant difference between patients with beneign endometrium, endometrial hyperplasia and endometrial carcinoma as regarding age ,using Independent sample t-test.

In the current Study the difference between patients with benign endometrial pathology compared to that of either endometrial hyperplasia or carcinoma are (49.6±2.6 , 51.7±2.8) as in table (6). In the current Study the difference between patients with benign endometrial pathology and endometrial hyperplasia compared to that of endometrial carcinoma are (50.8±2.9 , 51.7±2.7) as in table (9).

In the current study the difference between patients with benign endometrial pathology, endometrial hyperplasia and endometrial carcinoma as regarding Mean BMI are( 33.4±6.1 , 35.4±5.0 ,35.1±5.3) respectively as in table (4). These results are statistically significant using Independent sample t-test. While the difference between patients with benign endometrial pathology compared to endometrial Hyperplasia and endometrial carcinoma as regarding BMI are (33.4±6.1 ,35.3±5.1)as in table (6). While the difference between patients with benign endometrial pathology and endometrial hyperplasia compared to endometrial carcinoma as regarding BMI are (35.4±5.6 ,35.1±5.3) as in table (9).

In the current study concerning the difference between patients with benign endometrium, endometrial hyperplasia and endometrial carcinoma as regarding mean parity are (4(3 -5) , 3(2-4) ,2(1-3)) respectively as in table (4). While the difference between patients with benign endometrial pathology and endometrial carcinoma are [4 (3-5) and 2 (1-3)] respectively as regarding parity, using Mann-Whitney, which are statistically significant.

While The difference between benign endometrial pathology compared to endometrial hyperplasia and carcinoma as regarding mean parity are (4 (3-5), 3 (1-4)) as in table (6) which are significant using Mann-Whitney test.