Transvaginal Ultrasonography and Hysteroscopy in Evaluation of Abnormal Uterine Bleeding- A Cross-sectional Study

Abstract

Introduction: In perimenopausal age group particularly, 70% of all gynaecological consultations are for Abnormal Uterine Bleeding (AUB). About 30% of women seek medical assistance for AUB during their reproductive age group and about one third of hysterectomies are carried out for AUB alone. Aim: To determine the sensitivity, specificity, positive predictive value and negative predictive value of Transvaginal Ultrasonography (TVS) versus hysteroscopy in detecting uterine abnormalities Materials and Methods: A cross-sectional study in patients with AUB, admitted to the Department of Obstetrics and Gynaecology at RGGWCH, Puducherry between February 2016 and February 2017 who met the inclusion criteria were included. Sample size was 85 cases. After taking detailed history and physical examination the patient was investigated to rule out organic causes of AUB and then TVS and hysteroscopy were done. Any intrauterine pathology was looked for and endometrial sampling was taken from the abnormal sites for Histopathological Examination (HPE). Both TVS and hysteroscopy results were compared with histopathology which is the gold standard. Results: The sensitivity of TVS in diagnosis of uterine fibroid in comparison to hysteroscopy was 94.74% and the specificity was 71.21%. The sensitivity of hysteroscopy in diagnosis of endometrial hyperplasia in comparison to HPE was 75% and the specificity was 87.01%. The sensitivity of TVS in diagnosis of endometrial hyperplasia in comparison to HPE was 37.5% and the specificity was 90.91%. The sensitivity of hysteroscopy in diagnosis of polyp in comparison to HPE was 100% and the specificity was 97.3%. The sensitivity and specificity of TVS in diagnosis of polyp in comparison to HPE were 9.09% and 93.24%, respectively. Conclusion: TVS had a high sensitivity to detect fibroids but its value in detecting hyperplasia and polyps was in question in this study. But hysteroscopy had a maximum sensitivity to detect polyps and high sensitivity to detect endometrial hyperplasia compared to histopathology which is a gold standard investigation.