Diagnosis of endometrial hyperplasia in routine gynecological practice
DOI:
https://doi.org/10.14739/2310-1210.2019.1.155836Keywords:
endometrial hyperplasia, ultrasonographyAbstract
Objective. To estimate the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) in diagnosis of endometrial hyperplasia using transvaginal ultrasonography (TVS) versus histopathological findings.
Materials and methods. This is a retrospective study of 156 patients who underwent hysteroresectoscopy or diagnostic curettage. A comparative analysis of the preoperative diagnosis according to the TVS and postoperative diagnosis according to the histopathological conclusion was performed. All the patients were divided into 2 groups based on the TVS results before the procedure. Group 1 included 71 women with preoperative diagnosis of endometrial hyperplasia. Group 2 consisted of 85 women who underwent hysteroresectoscopy or diagnostic curettage for some other reasons. Using the statistical and mathematical methods, we determined the diagnostic value of TVS for diagnosis of both endometrial hyperplasia and pathology requiring subsequent invasive intervention into the uterine cavity.
Results. According to histopathological findings, endometrial hyperplasia was found only in 35 (49.30 % PPV) out of the 71 patients who were positively diagnosed using TVS. The other 36 patients (50.70 %) had a negative histopathological diagnosis.
The women of Group 2 were diagnosed correctly (absence of endometrial hyperplasia) in 52 cases (61.18 % NPV), but findings were positive in 33 (38.82 %) women according to histopathological examination. The sensitivity of TVS in the diagnosis of endometrial hyperplasia was 51.47 % (95 %CI 39.03–63.78) and the specificity was 59.09 % (95 %CI 48.09–69.46). However, the absence of indications for invasive intrauterine intervention was observed only in 4.22 % of women in Group 1 and in 2.35 % in Group 2.
Conclusions. TVS has a low diagnostic value to identify an endometrial hyperplasia. TVS has a high diagnostic value for determination of intrauterine pathology which requires further hysteroresectoscopy or diagnostic curettage. Low diagnostic value of TVS in the diagnosis of endometrial hyperplasia necessitates an additional analysis considering the qualification of specialists performing ultrasound, the adequacy of the MOH Order No. 676 fulfillment, warranting reflection of parameters such as the endometrium structure, polypoid inclusions, sound conductivity, outer contour of the M-echo and uterine cavity surface as well as the endometrial-uterine ratio calculation in peri-and post-menopausal patients.
References
Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., et al. (2015). Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer, 136(5), E359–E386. doi: 10.1002/ijc.29210.
Jones, A., Teschendorff, A. E., Li, Q., Hayward, J. D., Kannan, A., Mould, T., et al. (2013). Role of DNA Methylation and Epigenetic Silencing of HAND2 in Endometrial Cancer Development. PLoS Medicine, 10(11), e1001551. doi: 10.1371/journal.pmed.1001551.
Rodriguez, A. M., Schmeler, K. M., & Kuo, Y.-F. (2016). Lack of improvement in survival rates for women under 50 with endometrial cancer, 2000–2011. Journal of Cancer Research and Clinical Oncology, 142(4), 783–793. doi: 10.1007/s00432-015-2092-1.
Gressel, G. M., Parkash, V., & Pal, L. (2015). Management options and fertility-preserving therapy for premenopausal endometrial hyperplasia and early-stage endometrial cancer. International Journal of Gynecology and Obstetrics, 131(3), 234–239. doi: 10.1016/j.ijgo.2015.06.031.
Sletten, E. T., Arnes, M., Lysa, L. M., Moe, B. T., Straume, B., & Orbo, A. (2017). Prediction of Relapse After Therapy Withdrawal in Women with Endometrial Hyperplasia: A Long-term Follow-up Study. Anticancer Research, 37(5), 2529–2536. doi: 10.21873/anticanres.11595.
Sanderson, P. A., Critchley, H. O., Williams, A. R., Arends, M. J., & Saunders, P. T. (2016). New concepts for an old problem: the diagnosis of endometrial hyperplasia. Human Reproduction Update, 23(2), 232–254. doi: 10.1093/humupd/dmw042.
Chandra, V., Kim, J. J., Benbrook, D. M., Dwivedi, A., & Rai, R. (2016). Therapeutic options for management of endometrial hyperplasia. Journal of Gynecologic Oncology, 27(1), e8. doi: 10.3802/jgo.2016.27.e8.
Ministerstvo okhorony zdorovia (2014) Nakaz MOZ Ukrainy «Pro vnesennia zmin do nakaziv MOZ Ukrainy vid 29 hrudnia 2005 roku №782 ta vid 31 hrudnia 2004 roku №676 «Pro zatverdzhennia klinichnykh protokoliv z akusherskoi ta hinekolohichnoi dopomohy» vid 24.03.2014 r. №205 [Order of the Ministry of Health of Ukraine «On Amendments to the Orders of the Ministry of Health of Ukraine» from December 29, 2005 №782 and from December 31, 2004 №676 «On Approval of Clinical Protocols on Obstetric and Gynecological Aid» from March 24, 2014 №205]. [in Ukrainian].
Wanderley, M. D., Álvares, M. M., Vogt, M. F., & Sazaki, L. M. (2016). Accuracy of Transvaginal Ultrasonography, Hysteroscopy and Uterine Curettage in Evaluating Endometrial Pathologies. Revista Brasileira de Ginecologia e Obstetricia : Revista Da Federacao Brasileira Das Sociedades de Ginecologia e Obstetricia, 38(10), 506–511. doi: 10.1055/s-0036-1593774.
Yela, D. A., Pini, P. H., & Benetti-Pinto, C. L. (2018). Comparison of endometrial assessment by transvaginal ultrasonography and hysteroscopy. International Journal of Gynecology & Obstetrics, 143(1), 32–36. doi: 10.1002/ijgo.12567.
(2018) MedCalc statistical software. Retrieved from https://www.medcalc.org/index.php
Kurman, R. J., Carcangiu, M. L., & Young, R. H. (Eds.). (2014). WHO Classification of Tumours of Female Reproductive Organs. Lyon, 2014: International Agency for Research on Cancer (IARC).
Woodfield, C. A. (2018). The Usefulness of Ultrasound Imaging in Gynecologic Oncology. PET Clinics, 13(2), 143–163. doi: 10.1016/j.cpet.2017.11.003.
Froyman, W., & Timmerman, D. (2012). Dewhurst’s Textbook of Obstetrics & Gynaecology. Oxford: Wiley-Blackwell. doi: 10.1002/9781119979449.
Patel, V., Wilkinson, E. J., Chamala, S., Lu, X., Castagno, J., & Rush, D. (2017). Endometrial Thickness as Measured by Transvaginal Ultrasound and the Corresponding Histopathologic Diagnosis in Women with Postmenopausal Bleeding. International Journal of Gynecological Pathology, 36(4), 348–355. doi: 10.1097/PGP.0000000000000344.
Maiti, G., Lele, P., & Borse, D. (2018). Comparison of transvaginal sonography with hysteroscopy and correlation with histopathological report in case of abnormal uterine bleeding. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 7(2), 710–714. doi: http://dx.doi.org/10.18203/2320-1770.ijrcog20180199
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
