Fatma BEYAZIT, Buket AYDIN, Eren PEK, Mesut ÜNSAL

Sociodemographic and pathological characteristics of women who underwent endometrial curettage for abnormal uterine bleeding in a university referral center

Abnormal uterine bleeding (AUB) is an important clinical concern among reproductive-aged women, and is usually associated with benign or malignant gynecologic conditions. The aim of the present study is to determine the clinical spectrum of AUB patients and to investigate the relationship between indications and histopathological results of AUB patients undergoing endometrial sampling. A total of 625 female patients who presented to Canakkale Onsekiz Mart University Hospital between October 2013 and October 2017 due to non-obstetric gynecological causes and underwent endometrial sampling included in the present study. The median age of patients was 46 years (min-max: 28-90 years) and the most common clinical presentation was represented by menometrorrhagia/menorrhagia (50.4%) followed by postmenopausal bleeding (38.6%), and myoma uteri (9.3%). Endometrial sampling evaluation revealed various patterns on histopathology. The most common encountered diagnosis was proliferative-secretory endometrium (41.3%), followed by endometrial polyp (20.2%) and simple hyperplasia without atypia (9.6%). Endometrial cancer was observed more frequently in the post-menopausal bleeding. AUB which often prevails as an important and common gynecological ailment in perimenopausal women is commonly due to dysfunctional in origin. Therefore routine endometrial biopsy should not be an initial clinical investigation for menorrhagia. It should be preferred in case of persistent menorrhagia in conjunction with presence of additional risk factors.

PDF

___

Bacon JL. Abnormal Uterine Bleeding: Current Classification and Clinical Management. Obstet Gynecol Clin North Am. 2017;44:179-93.

Ely JW, Kennedy CM, Clark EC, et al. Abnormal uterine bleeding: a management algorithm. J Am Board Fam Med. 2006;19:590-602.

Inal ZO, Inal HA, Kucukosmanoglu I, et al. Assessment of Endometrial Sampling and Histopathological Results: Analysis of 4,247 Cases. Eurasian J Med. 2017;49:44-7.

Goncharenko VM, Beniuk VA, Kalenska OV, et al. Predictive diagnosis of endometrial hyperplasia and personalized therapeutic strategy in women of fertile age. EPMA J. 2013;4:24.

Du J, Li Y, Lv S, et al. Endometrial sampling devices for early diagnosis of endometrial lesions. J Cancer Res Clin Oncol. 2016;142:2515-22.

Leclair CM, Zia JK, Doom CM, et al. Pain experienced using two different methods of endometrial biopsy: a randomized controlled trial. Obstet Gynecol. 2011;117:636-41.

Sanam M, Majid MM. Comparison the Diagnostic Value of Dilatation and Curettage Versus Endometrial Biopsy by Pipelle--a Clinical Trial. Asian Pac J Cancer Prev. 2015;16:4971-5.

Gungorduk K, Asicioglu O, Ertas IE, et al. Comparison of the histopathological diagnoses of preoperative dilatation and curettage and Pipelle biopsy. Eur J Gynaecol Oncol. 2014;35:539-43.

Dijkhuizen FP, Mol BW, Brölmann HA, et al. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer. 2000;89:1765-72.

Patil P, Venigalla S, Kumar MLH, et al. A Comparative Evaluation of the Three Different Methods of Endometrial Sampling in the Diagnosis of Perimenopausal Bleeding. J Clin Gynecol Obstet. 2014;3:133-7.

Christianson MS, Barker MA, Lindheim SR. Overcoming the challenging cervix: techniques to access the uterine cavity. J Low Genit Tract Dis. 2008;12:24-31.

van Hanegem N, Prins MM, Bongers MY, et al. The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2016;197:147-55.

Matsubara S, Ohkuchi A, Nonaka H, et al. Prolapse of the small intestine from the uterine perforation at dilatation and curettage. Case Rep Obstet Gynecol. 2014;2014:164356.

Spencer CP, Whitehead MI. Endometrial assessment re-visited. Br J Obstet Gynaecol. 1999;106:623-2.

Cintesun E, Incesu FN Aslan BK, et al. Results Of Our Endometrial Samplings: Analysis Of 655 Cases. JGON. 2017;14:56-9.

Kucur SK, Şencan H, Yüksel KB, et al. Evaluation Of Endometrial Biopsy Results In Our Clinic; Analysis of 744 Cases. Zeynep Kamil Tıp Bülteni. 2014;45:146-50.

Jetley S, Rana S, Jairajpuri ZS. Morphological spectrum of endometrial pathology in middle-aged women with atypical uterine bleeding: A study of 219 cases. J Midlife Health. 2013;4:216-20.

Çakmak B, Karataş A, Turan G. Results of Our Endometrial Samplings: Analysis of 400 Cases. Selçuk Tıp Derg. 2012;28:163-6.

Pennant ME, Mehta R, Moody P, et al. Premenopausal abnormal uterine bleeding and risk of endometrial cancer. BJOG. 2017;124:404-11.

Painter JN, O’Mara TA, Batra J, et al. Fine-mapping of the HNF1B multicancer locus identifies candidate variants that mediate endometrial cancer risk. Hum Mol Genet. 2015;24:1478-92.

Sweet MG, Schmidt-Dalton TA, Weiss PM, et al. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2012;85:35-43.

Singh S, Best C, Dunn S, et al. Abnormal uterine bleeding in pre-menopausal women. J Obstet Gynaecol Can. 2013;35:473-5.

Khare A, Bansal R, Sharma S, et al. Morphological spectrum of endometrium in patients presenting with dysfunctional uterine bleeding. People’s J Sci Res. 2012;5:13–6.

Tuncer R, Uygur D, Kis S. Ankara Zübeyde Hanım Doğumevi 2000 Yılı endometrial biopsi sonuçları: 676 olgunun analizi. MN Klinik Bilimler&Doktor. 2003;9:97–9.