Ramya, Ponnuswamy (2010) Accuracy of Transvaginal Ultrasonography in Prediction of Endometrial Pathology in Post Menopausal Women. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Health aspects in postmenopausal women have gained importance in recent years owing to the increased life expectancy. According to WHO, the disability adjusted life expectancy (DALE) exceeds 70 yrs in about 24 countries, with women living longer than men by an average of 7 to 8 years. The average age at menopause ranges from 45 yrs in the Indian woman to 51 years in the Western population depending on the hereditary, life style and nutritional factors. Thus a woman spends more than two to three decades of life in her menopause. The principal gynecological cancers (breast, ovary, uterus, and cervix) account for over 40% of cancers found in women worldwide. However, large differences exist, in both their incidence and geographical distribution. Endometrial cancer is currently the most common gynecological malignancy in developed countries. A number of reports have suggested that the incidence of carcinoma of the endometrium is increasing in the United States and other industrialised countries. The incidence of endometrial cancer is 3.7% to 17.9% in postmenopausal women with abnormal uterine bleeding. The incidence of endometrial cancer in asymptomatic women was 0.13% and atypia was seen in 0.63%. Endometrial carcinoma fortunately when detected early can be cured with less morbidity and mortality. It has much higher cure rates if diagnosed early. Localised disease (stage I and II) has a 5 year survival of 87% and 76% respectively, but much poorer for stage III with 5 yr survival rate of <60%. Endometrial polyps often have hyperplastic changes and the risk of premalignant to malignant polyp increases with age, menopausal status and hypertension. In contrast to cervical cancer, there are no routine mass screening programmes for the early detection of endometrial abnormalities. AIM OF THE STUDY: 1. To evaluate the role of transvaginal ultrasonography in evaluating endometrial pathology in postmenopausal women using endometrial thickness measurements and morphological changes within the endometrium to define abnormality and able to choose the technique of biopsy if needed. 2. To assess the utility of TVS as a routine screening tool in detecting endometrial disease in all postmenopausal women. MATERIALS AND METHODS: A total of 105 postmenpausal women who attended the Gynaecology outpatient department at the Institute of Obstetrics and Gynecology from April 2008 to September 2009 were screened for this study. The women were selected based on the inclusion and exclusion criteria. Inclusion Criteria: - Last menstrual cycle at least one year back (Menopausal women). - All patients with complaints of post menopausal bleeding. - Endometrial thickness more than 5 mm in asymptomatic women. - Age 40 years and above. - Not on any hormonal treatment. - Absence of other pelvic diseases and blood dyscrasis. Exclusion Criteria: - Carcinoma cervix. - Other pelvic pathologies or blood dyscrasis. - Hormonal treatment. - Endometrial thickness less than 5 mm in asymptomatic women. SUMMARY: A total of 105 postmenopausal women were involved in the study carried out from April 2008 to September 2009 at the Institute of Obstetrics and Gynaecology, MMC, Chennai. • TVS was done followed by histopathological diagnosis was made which was considered the gold standard. • Age of women ranged from 42 to 73 years with 45% between 50 to 60 years. • Most of the women were within 10 years of attaining menopause. • A total of 30.5% had associated diseases such as hypertension, diabetes and other carcinomas which were significantly associated with endometrial disease. • BMI had no relation with endometrial disease. • Of all women 66.7% had postmenopausal bleeding and the rest were asymptomatic. • Postmenopausal bleeding and years of menopause had strong association with endometrial disease. • Morphological features including the appearance, characteristics, margins, endometrial halo and endometrial thickness produced significant association with endometrial disease. • The overall diagnostic accuracy of TVS was 86.7%. • The overall sensitivity, specificity, positive predictive value and negative predictive values were 80.0%, 88.2%, 61.5% and 94.9%. • The accuracy of diagnosis was better in women with postmenopausal bleeding than those without bleeding. CONCLUSIONS Transvaginal sonography is safe, simple, non invasive and cost effective in the diagnosis of endometrial disease. • It can be used as the first line investigation in women with postmenopausal bleeding. • A lesion if considered abnormal or suspicious can be further investigated and the mode of investigation can be decided based on findings. • Use of saline infusion sonohysterography along with TVS can increase the accuracy of findings especially in diagnosing endometrial polyps. • The combination of morphological features with endometrial thickness on gray scale ultrasound increases the diagnostic accuracy than with endometrial thickness alone. • The routine use of TVS for screening of endometrial disease is not useful in postmenopausal women.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Accuracy ; transvaginal ultrasonography ; prediction ; endometrial pathology ; post menopausal women. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 12:08 |
| Last Modified: | 09 Dec 2017 12:51 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4100 |
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