Examining the Association between Endometrial Thickness in Transvaginal Ultrasound and Results of Pipelle Endometrial Sampling in Perimenopausal Women with Abnormal Uterine Bleeding

Abstract

95%) [4, 28]. Additionally, in some patients, an outpatient biopsy cannot be performed properly due to cervical stenosis, the patient’s intolerance, or the fact that the sample does not provide sufficient data to reject cancer (In 5 to 15% of cases) [10, 31-33]. Furthermore, in cases of endometrial sampling when no diagnoses can be reached, a transvaginal ultrasound is helpful. A thin and homozygous endometrium has a high negative predictive value for performing other invasive procedures such as dilatation and surgical curettage. Pipelle sampling is carried out by a thin device with an external diameter of usually 3mm sampled by an aspiration. Although it often passes through the cervix easily, it is sometimes accompanied by pain. Approximately 4% of the uterine cavity is sampled by this method. The sensitivity of this method to evaluate endometrial abnormalities is about 85% [30, 34]. The aim of this study was to investigate the association between endometrial thickness in ultrasound and the results of Pipelle endometrial sampling. Materials and Methods In this cross-sectional descriptive study, all women with abnormal uterine bleeding including menorrhagia, irregular menstruation, postintercourse bleeding, and metrorrhagia who referred to Rasoul Akram and Akbarabadi Hospitals, Tehran, Iran in 2016 and 2017 were considered. 75 people were studied, out of which 70 people were eligible and were included in the study. Among these patients (n=70), the results of Pipelle endometrial sampling of 2 patients were non-diagnostic; therefore, they were excluded from the study. Finally, 68 perimenopausal women with abnormal uterine bleeding were examined. Inclusion criterion was perimenopausal people aged 35 to 55 years with abnormal uterine bleeding and the exclusion criteria were people with a history of cervical 67 Parisa Dini et al. Journal of Obstetrics, Gynecology and Cancer Research Spring 2018, Volume 3, Issue 2 surgery, susceptibility to local anesthesia, hemodynamic instability, hemorrhage due to systemic diseases such as coagulation and/or thyroid diseases, regular drug-induced bleeding, virgin women, bleeding caused by cervical and vaginal diseases, and fibroids. After inquiring into the patient’s history and carrying out physical examinations, the patients were subjected to a transvaginal ultrasound. In a transvaginal ultrasound, various criteria such as uterine size, endometrial ecchymosis, fibroids and polyps, and adnexal masses were evaluated. All ultrasounds were performed by an operator. The procedures were explained to all of these patients. The data related to their age, main complaints, duration of the problem, history of previous illnesses, history of menstrual-based problems, blood problems, and general physical examinations, as well as examinations of the abdomen and pelvis of these patients, were recorded in the relevant checklists. A chi-square, Mann Whitney, Kruskal Wallis, and Spearman tests were used. The obtained data were analyzed using SPSS 22. Findings The mean age of the participants was 47.09±4.33 years (The youngest person was 40 years old and the oldest person was 56 years old). Additionally, the mean duration of menometrorrhagia in these patients was 22.43±5.28 months, which was reported to be at least 1 month and at most 166 months. There was no significant association between clinical characteristics of the patients in the benign and malignant groups except the history of C-section (Table 1). There was no significant association between the results of Pipelle endometrial sampling and taking the medications (Diagram 1; p=0.24). It was indicated that the proliferative endometrium with a prevalence of 27 cases (39.7%) was the most common pathologic finding in this study. Moreover, the prevalence of malignancy in perimenopausal women with abnormal uterine bleeding was reported as 10.3% (Table 2). According to the ultrasound results, the mean thickness of the endometrium was reported to be 8.38±3.67mm, with a minimum thickness of 3mm and a maximum of 19mm. The mean endometrial thickness in the patients with benign diagnoses was 7.55±2.72mm and in the patients with malignant diagnoses was 15.57±2.99mm, which was not statistically significant (p<0.001). Statistical means of endometrial thickness obtained from vaginal ultrasounds in pathological diagnoses of Pipelle endometrial sampling showed that the mean thickness of the endometrium was significantly greater in malignant diagnoses (Table 3; p=0.001). Table 1) A comparison of the patients’ clinical data based on the results of Pipelle endometrial sampling: benign and malignant (n=68, the numbers in parentheses represent percentage) Variable Benign (n=61) Malignant (n=7) p-value Body mass index (kg/m2)-number (%) Normal (18.5-24.9) 28 (41.2) 6 (8.8) 0.17 Overweight (25-29.9) 28 (41.2) 1 (1.5) Obese (30-34.9) 5 (7.3) Duration of menometrorrhagia 1 year≥ 37 (54.4) 4 (5.9) 0.85 1 year< 24 (35.3) 3 (4.4) Diabetes Yes 7 (10.3) 0.34 No 54 (79.4) 7 (10.3) Thyroid diseases Yes 12 (17.6) 0.19 No 49 (72.1) 7 (10.3) History of cardiovascular diseases Yes