Limits...
Intra-cavitary uterine pathology in women with abnormal uterine bleeding: a prospective study of 1220 women.

Van den Bosch T, Ameye L, Van Schoubroeck D, Bourne T, Timmerman D - Facts Views Vis Obgyn (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.

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.

No MeSH data available.


Related in: MedlinePlus

Endometrial polyp (gel instillation sonography at grey scale and power Doppler imaging): note the pedicle artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4402439&req=5

Figure 3: Endometrial polyp (gel instillation sonography at grey scale and power Doppler imaging): note the pedicle artery.

Mentions: Colour Doppler imaging enables the visualization of vessels within the endometrium. In endometrial polyps the ‘pedicle artery sign’ (Timmerman et al., 2003) is often visible using CDI (Fig. 3), a fibroid often shows circumferential vascularization (Fig. 4), and the visualization of one or more dominant vessels within the endometrium with CDI is commonly associated with endometrial cancer (Opolskiene et al., 2011). In our study increased vascularity was reported in half of the cancer cases and in one third of the patients with focal intracavitary lesions. Small vessels may not be detected with CDI and transient myometrial contractions may result in an intermittent absence of flow signals (Van den Bosch et al., 2002), leading to false negative results as reflected by the suboptimal LR- both in pre- and postmenopausal women (Table II and III).


Intra-cavitary uterine pathology in women with abnormal uterine bleeding: a prospective study of 1220 women.

Van den Bosch T, Ameye L, Van Schoubroeck D, Bourne T, Timmerman D - Facts Views Vis Obgyn (2015)

Endometrial polyp (gel instillation sonography at grey scale and power Doppler imaging): note the pedicle artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4402439&req=5

Figure 3: Endometrial polyp (gel instillation sonography at grey scale and power Doppler imaging): note the pedicle artery.
Mentions: Colour Doppler imaging enables the visualization of vessels within the endometrium. In endometrial polyps the ‘pedicle artery sign’ (Timmerman et al., 2003) is often visible using CDI (Fig. 3), a fibroid often shows circumferential vascularization (Fig. 4), and the visualization of one or more dominant vessels within the endometrium with CDI is commonly associated with endometrial cancer (Opolskiene et al., 2011). In our study increased vascularity was reported in half of the cancer cases and in one third of the patients with focal intracavitary lesions. Small vessels may not be detected with CDI and transient myometrial contractions may result in an intermittent absence of flow signals (Van den Bosch et al., 2002), leading to false negative results as reflected by the suboptimal LR- both in pre- and postmenopausal women (Table II and III).

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.

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.

No MeSH data available.


Related in: MedlinePlus