Nalini, L (2007) A Comparative study of the endometrium by aspiration and hysteroscopy directed biopsies in abnormal uterine bleeding in perimenopausal women. Masters thesis, Madras Medical College, Chennai.
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Abstract
This present, prospective, descriptive study analyzing the role of endometrial sampling as an outpatient procedure using Pipelle in women with perimenopausal bleeding was carried out at Government Kasturba Gandhi Hospital, Madras Medical College, Chennai during the period October 2004 to May 2006 A total of 200 patients were included in the study. All the patients underwent an initial assessment using, Pipelle’s curette followed by hysteroscopyguided biopsy. Those patients with abnormal findings and those not responding to medical management underwent hysterectomy. The final diagnosis obtained after hysterectomy was designated as the gold standard against which the findings of Pipelle’s aspiration was compared & analyzed for statistical significance. Observations in this study includes · Patients in the study group were 35 years and above with 74% of them belonging to the 40-50 age group. · The study encompasses women of any parity with majority of them belonging to the low socioeconomic status. · Majority of patients (74%) had presented within 1 yr of onset of symptoms · Both Pipelle’s curette and hysteroscopic biopsy produced statistically significant results while evaluating perimenopausal bleeding. (p = 0.000) · When histopathology of the endometrium was obtained using Pipelle’s curette, correct diagnosis could be obtained in 93% of the cases. · Similarly when hysteroscopy was performed the correct diagnosis was 98% · Pipelle showed a sensitivity of 100% specificity of 72% in the detection of abnormal findings with PPV of 92% and NPV of 100% · However accuracy of hysteroscopy is found to be less in the diagnosis of polyps and sub mucous fibroids with accuracy of 100% · The low specificity could be attributed to the inability of the device to diagnose focal processes like polyp in the endometrium. CONCLUSION · Endometrial sampling as outpatient procedure using Pipelle is a safe, simple, minimally invasive procedure with no complications. · Pipelle’s gives near equal percentage of correct diagnosis that is statistically significant when hysteroscopy and hysterectomy are correlated. · Thus Endometrial sampling as an outpatient (ESOP) procedure is a simple, safe and reliable way to undertake first line assessment of abnormal uterine bleeding in the perimenopausal age group where the incidence of abnormal findings itself is very low. This is particularly relevant in a setting where more advanced methods are not readily available. · ESOP can reliably classify a lesion as benign or hyperplasia accurately. · Though hysteroscopy is an acceptable procedure and can be reassuring, it did not influence clinical management, especially with respect to hysterectomy rate. Thus for abnormal uterine bleeding in perimenopausal women, , Endometrial Sampling as an Outpatient (ESOP) procedure has a central role in the new guidelines for the management of Dysfunctional Uterine Bleeding, before considering any other diagnostic modalities. Therefore a need exists to broaden its use and include it in the routine diagnostic armamentarium.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Comparative study ; endometrium ; aspiration ; hysteroscopy directed biopsies ; abnormal uterine bleeding ; perimenopausal women. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 03 Dec 2017 10:49 |
| Last Modified: | 09 Dec 2017 01:28 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4164 |
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