Histopathological Association with Abnormal Uterine Bleeding by Using Diagnostic Hysteroscopy

Neranjana D and Jayalakshmi G^*

^*Correspondence: Jayalakshmi G, Department of Microbiology, Sri Lakshmi Narayana Institute of Medical Sciences, Affiliated to Bharath Institute of Higher education and Research, India, Email:

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Introduction

Clinical management objectives are generally determined by obtaining an accurate etiological assessment. The history, physical examination, and thorough assessment are all used to try to figure out where the bleeding is coming from and what is causing it. The knowledge gained will help determine the path of the study. The most common studies used in the assessment of the etiology of abnormal uterine bleeding were classically dilatation and curettage and ultrasonography [1,2]. Because dilatation and curettage is a blinded treatment, the endometrium must be delivered to a scientist for histological analysis and a conclusion. The pathologist's participation is critical. Ultrasonography obviously indicates the uterine contour and ovarian status; however it does not provide enough knowledge on the endometrium. In the examination of abnormal uterine bleeding, hysteroscopy has brought a new age [3]. In the majority of situations, direct imaging of the uterine cavity can diagnose the aetiology. It is capable of detecting endometrial hyperplasia and assisting in the early identification of endometrial cancer and uterine polyps [4].

One of the most prevalent problems that patients bring to a Gynecologist is abnormal uterine bleeding. D&C has traditionally been the standard method in the diagnosis of abnormal uterine bleeding. However, only about 70% to 80% of the endometrium can be cured. Curettage alone commonly fails to uncover polyps and submucous fibroids. The careful application of hysteroscopy to treat this medical condition adds another dimension to the treatment of this often perplexing issue. The goal of this review is to examine the role of hysteroscopy in the detection of Abnormal Uterine Bleeding in order to determine the accuracy of hysteroscopic observations and the procedure's impact to specific diagnosis. It also intends to link hysteroscopic findings to histological findings [5-7].

Materials and Methods

The data for this study came from individuals who were hospitalized to the Obstetrics and Gynecology department with abnormal uterine bleeding. Hysteroscopy and histological investigation were used to analyse the pattern of endometrium in 50 patients with AUB. All patients were given complete information about the trial and given formal informed consent. All of the study participants had hysteroscopy accompanied by curetting, with the curetting’s forwarded to Histopathology for evaluation. The research took place from March 2020 to August 2021. Hysteroscopy and Endometrial Histopathology data were examined and evaluated. The data was assessed and compared to comparable series in the research. A comprehensive chart has been prepared and presented that covers all topics. SPSS software was used for all statistical analysis.

Inclusion-measures

Patients age ranging 20 -60 years with uterine bleeding.

Both multi parous and nulliparous women were included.

Exclusion-measures

Profuse bleeding cases.

Cases of carcinoma cervix.

Patients on hormonal drugs.

The cases were chosen based on the diagnoses made during the history, comprehensive clinical assessment, abdominal and bimanual pelvic examinations, and routine procedures. The night before hysteroscopy, participants were recommended to have a light dinner before 10 p.m. The participants were prepared in the same way as they would be for any other surgical treatment.

Results and Discussion

In this study, half of patients with Abnormal Uterine Bleeding had panoramic hysteroscopy with a 4mm hysteroscopic with a 30 degree oblique lens (Kalelkar, India) and were then treated with Curettage. Histopathological examination of the curetted endometrium was performed. The maximum age occurrence in this study was between 30-39, with 20 cases (40 percent). The study's youngest patient was 24, and the oldest was 60 (Table 1).

Table 1: Age range in study.

The most of the trauma patients had problems for more than a year: 21 (42%) had difficulties for more than a year, 15 (30%) had difficulties for 6 months to a year, and 14 (28%) had difficulties for less than 6 months. Menorrhagia was the most common symptom in 23 (46%) of the patients. Postmenopausal Bleeding was the second most prevalent group, with 16 instances (32 percent). Polymenorrhagia affected 6 individuals (12%), while Metrorrhagia affected 5 patients (10%) which are shown in Figure 1.

Figure 1. Clinical presentation.

In 23 individuals (46%), aberrant results were found, whereas no abnormality was found in the remaining 27 patients (54%) (Negative hysteroscopic view). Thickened Endometrium (10 instances, 20%) was the most prevalent anomaly, followed by Endometrial Polyps (7 cases, 14 percent). There were also two cases of SubmucousMyomas (4%), three cases of Endometrial Atrophy (6%), and one case of Endometritis (2%). Histopathology revealed two aberrant findings: one case of endometrial atrophy and one case of endometritis. On hysteroscopy, one incidence of endometritis was later identified as normal (Figure 2).

Figure 2. Findings at hysteroscopy.

In 50 consecutive instances of AUB, diagnostic hysteroscopy was done, and its association with histological results was explored. Menorrhagia (46%) was the most prevalent presenting ailment in this study, followed by Postmenopausal Bleeding (32%), and Polymenorrhea (22%) (12 percent). Menorrhagia accounted for 60% of the cases in Panda's 33 series. In this study, aberrant results on hysteroscopy were discovered in 23 individuals (46%), whereas no abnormality was identified in the remaining 27 patients (54%). The test made a false positive diagnosis of endometritis in one case and missed the identification of endometrial atrophy and endometritis in one case [8- 11]. In this study, hysteroscopy accuracy was 94 percent, while endometrial histopathology accuracy was 88 percent. A comparison of the accuracy of the product to that of other similar products (Table 2).

Table 2: Identification after hysteroscopy and histopathology.

Statistical analysis of hysteroscopy accuracy and precision; The sensitivity and specificity acquired in this study and those obtained by many other authors are not significantly different. This supports the findings of the current study's hysteroscopy (Table 3) [12,13].

Table 3: Accuracy of hysteroscopy diagnosis.

Hysteroscopy and dilatation and curettage findings were in accord in 82 percent of cases in the current study; hysteroscopy showed more data than curettage in 12 percent of cases, and curettage provided more knowledge than hysteroscopy in 6 percent of cases (Table 4). This study is consistent to others that have found that Panoramic Hysteroscopy is superior to curettage in detecting abnormal uterine haemorrhage.

Table 4: Comparison of validity factors curettage.

Conclusion

In examining individuals with uterine bleeding, hysteroscopy is preferable than curettage, according to this study. With high sensitivity, specificity, and negative predictive value, hysteroscopy is a safe, reliable, and rapid technique for diagnosing cases of irregular uterine bleeding. When analyzing irregular uterine bleeding, today's gynecologist is concerned about missing a major malignant tumour. If we conform to the criteria for a negative hysteroscopic examination, the odds of missing such a lesion are slim, and no additional study is typically required. Even if the hysteroscopic view is negative, it is important to take endometrial tissue for histological analysis, especially in peri or postmenopausal individuals.

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