The accuracy of endometrial sampling for the diagnosis of patterns of endometrial pathology in women presenting with abnormal uterine bleeding

Abstract

Objectives: Abnormal uterine bleeding (AUB) is a leading cause of hysterectomies, the cause of which is usually diagnosed with preoperative endometrial sampling. We planned this study to assess the accuracy of diagnosing the histologic patterns of endometrium in the preoperative sample in reference to the final histologic diagnosis in hysterectomy. Methods: We retrospectively reviewed medical charts between January 2011 and December 2015 at a tertiary hospital in Saudi Arabia and identified 43 cases of AUB with complete documentation. The histologic diagnoses were classified into normal and benign pathology group (N/B), or carcinoma and hyperplasia category (Ca/H). Measures of validity were used to compare endometrial sampling histological diagnoses to diagnoses following hysterectomy and Cohen’s kappa to assess for agreement between the 2 modalities. Results: The median age of all patients was 49 years. Preoperative histologic examination showed 53.8% sensitivity, 90% specificity, 70% positive predictive values and 81.8% negative predictive values, 30.1% false positive rates and 18.2% false negative rates. The agreement between preoperative and postoperative histologic diagnoses was moderate (79.1%, k=0.469). Conclusion: The accuracy of preoperative histologic examination was moderate. Our findings recommend cautious clinical decision making and limiting hysterectomy to women who do not respond to other therapeutic measures.

Preoperative MRI and immunohistochemical examination for the prediction of high-risk endometrial cancer

“…Preoperative endometrial sampling is an important approach for clinically suspected endometrial lesions, however, the conventional pathological technique is insufficient for risk assessment of EC. Notably, IHC examination can significantly improve the accuracy of diagnosis (7). Several studies report that IHC markers are important for identification of different pathologic subtypes and risk factors of EC.…”

“…Liu et al (5) reported that ADC has the potential to discriminate intermediate-and high-risk stage I EC patients, whereas Lee et al (6) reported that preoperative MRI and histological results can be used for identification of low-risk EC patients. However, results of risk prediction of EC using MRI or IHC alone show significant variations (6)(7)(8)(9). Therefore, it is important to explore the effect of combining preoperative MRI features and IHC markers on the predictive value for high-risk EC.…”

Modern View of the Problem of Endometrial Hyperplasia

“…Следовательно, можно сделать вывод, что гистероскопия является адекватным и надежным инструментом для оценки доброкачественной патологии в полости матки. Визуальных результатов может быть недостаточно, и для повышения точности диагностики может потребоваться направленная биопсия [2,17,18].…”

Pathology findings among women with alterations in uterine bleeding patterns in cameroon

“…Alterations in uterine bleeding pattern such as abnormal uterine bleeding (AUB) and amenorrhea are among the most common gynecological problems worldwide ( Soleymani et al, 2014 , Al Nemer et al, 2019 ). AUB is a broad term used to denote all forms of uterine bleeding disorders irrespective of frequency, duration, and quantity.…”