Citation Information :
Pandey D, Kummarapurugu SV, Jain G, Kyalakond K, Pai P, Sayyad M, Pai MV. A Noninvasive Screening Tool for Abnormal Uterine Bleeding: An Attempt to Reduce Numbers of Endometrial Biopsies. Donald School J Ultrasound Obstet Gynecol 2020; 14 (1):4-10.
Introduction: Endometrial pathologies contribute to a large proportion of abnormal uterine bleeding (AUB). The aim of this study was to prospectively validate a novel scoring tool [diseases of endometrium–evaluation and risk scoring (DEERS)] as compared with the gold standard histology. Diseases of endometrium–evaluation and risk scoring is a scoring system based on patient characters and endometrial features that are visualized in gray scale transvaginal sonography (TVS). We hypothesized that this tool will help screen women who present with AUB for premalignant and malignant diseases of endometrium, in a noninvasive way. When performed routinely in women prior to subjecting them to endometrial sampling, it would reduce anxiety for the patient till the final histology report is awaited. It may also be used to help reduce the burden of unnecessary samplings to the clinicians as well as decrease the burden of histological slide review for the pathologist. Materials and methods: A total of 454 women were included. Patients with AUB in whom cervical, myometrial, ovarian, and endocrinal causes were ruled out and were planned for endometrial sampling were recruited for the study, as cases (n = 284). Women who were planned for hysterectomy for reason other than endometrial pathologies were taken as controls (n = 170). Preoperatively patient characteristics were noted, and TVS was performed to calculate DEERS for all. Results: In the study cohort, DEERS showed specificity of 100% for cancers, 88.12% for complex hyperplasia, 67.12% for benign lesions, and 76.35% for normal endometrium. However, the sensitivity of prediction was not encouraging. The 95% accuracy of the test for various lesions ranged from 60 to 97%. We noted a high efficacy (sensitivity of 72.2%, specificity of 92.1%) of DEERS in predicting malignant/premalignant diseases of endometrium, when coupled in one group. Conclusion: This scoring system looks promising for screening endometrial malignancy in women who present with AUB.
Doraiswami S, Johnson T, Rao S, et al. Study of endometrial pathology in abnormal uterine bleeding. J Obstet Gynaecol India 2011;61(4): 426–430. DOI: 10.1007/s13224-011-0047-2.
Matthews ML. Abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol Clin North Am 2015;42(1):103–115. DOI: 10.1016/j.ogc.2014.09.006.
Munro MG, Critchley HOD, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding: Malcolm G. Munro, Hilary O. D. Crithcley, Ian S. Fraser, for the FIGO working group on menstrual disorders. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet 2011;113(1):1–2. DOI: 10.1016/j.ijgo.2011.01.001.
Whitaker L, Critchley HOD. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol 2016;34:54–65. DOI: 10.1016/j.bpobgyn.2015.11.012.
Dueholm M, Hjorth IMD, Secher P, et al. Reproducibility of endometrial Pathologic findings obtained on hysteroscopy, transvaginal sonography, and gel infusion sonography in women with postmenopausal bleeding. J Minim Invasive Gynecol 2015;22(6):1036–1044. DOI: 10.1016/j.jmig.2015.05.019.
Schramm A, Ebner F, Bauer E, et al. Value of endometrial thickness assessed by transvaginal ultrasound for the prediction of endometrial cancer in patients with postmenopausal bleeding. Arch Gynecol Obstet 2017;296(2):319–326. DOI: 10.1007/s00404-017-4439-0.
Wong AS-W, Lao TT-H, Cheung CW, et al. Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study. BJOG Int J Obstet Gynaecol 2016;123(3):439–446. DOI: 10.1111/1471-0528.13342.
Pandey D, Kummarapurugu SV, Sayyad MG. A novel noninvasive screening tool for triaging endometrial pathologies in abnormal uterine bleeding: diseases of endometrium—evaluation and risk scoring. Gynecol Minim Invasive Ther 2018;7:183–184. DOI: 10.4103/GMIT.GMIT_73_18.
Misra A, Chowbey P, Makkar BM, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009;57:163–170.
Burbos N, Musonda P, Giarenis I, et al. Predicting the risk of endometrial cancer in postmenopausal women presenting with vaginal bleeding: the Norwich DEFAB risk assessment tool. Br J Cancer 2010;102(8):1201–1206. DOI: 10.1038/sj.bjc.6605620.
Musonda P, Burbos N, Duncan TJ, et al. Comparing the performance of two clinical models in estimating the risk of endometrial cancer in symptomatic postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2011;159(2):433–438. DOI: 10.1016/j.ejogrb.2011.09.005.
Opmeer BC, van Doorn HC, Heintz APM, et al. Improving the existing diagnostic strategy by accounting for characteristics of the women in the diagnostic work up for postmenopausal bleeding. BJOG Int J Obstet Gynaecol 2007;114(1):51–58. DOI: 10.1111/j.1471-0528.2006.01168.x.
Giannella L, Mfuta K, Setti T, et al. A risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women with endometrial thickness >4 mm. BioMed Res Int 2014;2014:130569. DOI: 10.1155/2014/130569.
Dueholm M, Hjorth IMD, Dahl K, et al. Ultrasound scoring of endometrial pattern for fast-track identification or exclusion of endometrial cancer in women with postmenopausal bleeding. J Minim Invasive Gynecology 2019;26(3):516–525. DOI: 10.1016/j.jmig.2018.06.010.
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 426: The role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. Obstet Gynecol 2009;113(2 Pt 1):462–464.
Timmermans A, Opmeer BC, Khan KS, et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol 2010;116(1):160–167. DOI: 10.1097/AOG.0b013e3181e3e7e8.
Jacobs I, Gentry-Maharaj A, Burnell M, et al. Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort. Lancet Oncol 2011;12(1):38–48. DOI: 10.1016/S1470-2045(10)70268-0.
Torrijos MCS, de Merlo GG, Mirasol EG, et al. Endometrial study in patients with postmenopausal metrorrhagia. Arch Med Sci AMS 2016;12(3):597–602.
Erenel H, Bese T, Sal V, et al. Comparison of diagnostic accuracies of serum HE-4 levels and 3D power doppler angiography parameters between benign endometrial pathologies and endometrial Cancer. Asian Pac J Cancer Prev APJCP 2016;17(5):2507–2511.
Makled AK, Elmekkawi SF, El-Refaie TA, et al. Three-dimensional power doppler and endometrial volume as predictors of malignancy in patients with postmenopausal bleeding. J Obstet Gynaecol Res 2013;39(5):1045–1051. DOI: 10.1111/j.1447-0756.2012.02066.x.
Mutz-Dehbalaie I, Egle D, Fessler S, et al. HE4 is an independent prognostic marker in endometrial cancer patients. Gynecol Oncol 2012;126(2):186–191. DOI: 10.1016/j.ygyno.2012.04.022.
Dueholm M, Hjorth IMD, Dahl K, et al. Identification of endometrial cancers and atypical hyperplasia: development and validation of a simplified system for ultrasound scoring of endometrial pattern. Maturitas 2019;123:15–24. DOI: 10.1016/j.maturitas.2019. 01.017.
Veena P, Baskaran D, Maurya DK, et al. Addition of power doppler to grey scale transvaginal ultrasonography for improving the prediction of endometrial pathology in perimenopausal women with abnormal uterine bleeding. Indian J Med Res 2018;148(3):302–308. DOI: 10.4103/ijmr.IJMR_96_17.
Plotti F, Capriglione S, Terranova C, et al. Validation of REM score to predict endometrial cancer in patients with ultrasound endometrial abnormalities: results of a new independent dataset. Med Oncol Northwood Lond Engl 2017;34(5):82. DOI: 10.1007/s12032-017- 0945-y.
Talukdar B, Mahela S. Abnormal uterine bleeding in perimenopausal women: correlation with sonographic findings and histopathological examination of hysterectomy specimens. J Midife Health 2016;7(2): 73–77. DOI: 10.4103/0976-7800.185336.
Moodley M, Roberts C. Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection. J Obstet Gynaecol J Inst Obstet Gynaecol 2004;24(7): 736–741. DOI: 10.1080/014436104100009394.
Munro MG, Southern California Permanente Medical Group's Abnormal Uterine Bleeding Working Group. Investigation of women with postmenopausal uterine bleeding: clinical practice recommendations. Perm J 2014;18(1):55–70.
Orekoya O, Samson ME, Trivedi T, et al. The impact of obesity on surgical outcome in endometrial cancer patients: a systematic review. J Gynecol Surg 2016;32(3):149–157. DOI: 10.1089/gyn.2015.0114.
Bouwman F, Smits A, Lopes A, et al. The impact of BMI on surgical complications and outcomes in endometrial cancer surgery—an institutional study and systematic review of the literature. Gynecol Oncol 2015;139(2):369–376. DOI: 10.1016/j.ygyno.2015.09.020.