A Noninvasive Screening Tool for Abnormal Uterine Bleeding: An Attempt to Reduce Numbers of Endometrial Biopsies

JOURNAL TITLE: Donald School Journal of Ultrasound in Obstetrics and Gynecology

1. Muralidhar V Pai
2. Gazal Jain
3. Sri V Kummarapurugu
4. Deeksha Pandey
5. Priya Pai
6. Keerthi Kyalakond
7. MG Sayyad
Publishing Year
Author Affiliations
1. com.mps.common.model.Contributor@e0270d9 ,
2. com.mps.common.model.Contributor@469c0052 ,
3. com.mps.common.model.Contributor@5a484a21 ,
4. com.mps.common.model.Contributor@95fd165 ,
5. com.mps.common.model.Contributor@1446ec2f ,
6. com.mps.common.model.Contributor@327ef065 ,
7. com.mps.common.model.Contributor@2a7fad49
Article keywords
Endometrium, Screening, Sonography, Uterine bleeding


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.

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