Clinicopathological Study of Perimenopausal Bleeding

Abstract

Introduction : Endometrial carcinoma is the fourth most common cancer in female and seventh leading cause of death from malignancy in the female. The present study was undertaken firstly, to know the spectrum of lesions of the endometrium with respect to perimenopausal bleeding and clinical features and secondly, to determine the pick-up rate of endometrial biopsy for various pre-malignant and malignant lesions of endometrium.

Material & Methods: This is a observational study with convenient sampling of 520 women of perimenopausal age group with AUB, presenting to gynecological OPD and wards of  Department of Obstetrics and Gynaecology, R. D. Gardi Medical College and associated C .R. Gardi Hospital, Ujjain. The study was conducted from May 2012 to June 2014. All those subjects who fulfilled the eligibility criteria were subjected to clinical examination, ultrasonography, and histopathological examination. 

Results: Overall Sensitivity of clinical examination with respect to ultrasonography is 26.2%, 28.6% with respect to histopathology. Overall Specificity of clinical examination with respect to ultrasonography is 84.5%, 84.7% with respect to histopathology. Overall PPV of clinical examination with respect to ultrasonography is 68.0%, 62.5% with respect to histopathology. Overall NPV of clinical examination with respect to ultrasonography is 46.8%, 57.1% with respect to histopathology.

Conclusion: The prime concern of this present study while evaluating abnormal uterine bleeding in women of perimenopausal age group is not to miss a significant cancerous lesion. The chances that such a lesion would be missed are rare, if we stick to the criteria for thorough clinical examination followed by ultrasonography and histopathology based on endometrial biopsy and usually no further expensive, cumbersome investigations may be necessary like saline infusion sonohysterography, hysteroscopy, enzyme histochemistry, hormone receptors. It would be prudent to obtain endometrial tissue for histopathological examination, in perimenopausal patients in spite of negative clinical and sonological view.