| Abstract: |
Diagnostic hysteroscopy, combined with histological examination of an endometrial aspiration or biopsy, is considered the ‘gold standard’ in the diagnosis of intrauterine abnormalities, and is recommended in women with abnormal uterine bleeding. Transvaginal Ultrasonography (TVS) is part of the essential technology that is needed for the proper evaluation of women with perimenopausal bleeding. Three-Dimensional (3D) ultrasound provides clearer visualization and more accurate evaluation of the uterine cavity.Objectives: The aim of the present study is to compare the accuracy of 3D transvaginal us and hysteroscopy in the diagnosis of uterine cavity lesions in cases of abnormal uterine bleeding.Patients and methods: In the present study, 50 patients were included from those attending the Obstetrics and Gynecology Outpatient Clinic at Zagazig University Hospitals during the period from February 2010 till December 2011. All the patients were admitted in the Zagazig University Hospitals for further investigations. They were not divided into subgroups, all patients were subjected to the following: full history taking, general examination, local examination, conventional transvaginal ultrasonography, detailed 3DUS examination of the uterus, detailed hysteroscopy examination, endometrial biopsy and endometrial histopathology. 3DUS was performed for patients with empty bladder, in the lithotomy position performed with Voluson 730D Pro 3D system.Prior to hysteroscopy, the following laboratory investigations were done: complete blood picture, fasting and 2 hour Postprandial (PP), blood sugar level, urine analysis, liver function tests, and kidney function tests. Taking pictures and saving on a floppy disk is the way of documentation of the ultrasonographic images. A hysteroscopic camer either of Karl Storz Germany or Wisap Autocontrol Germany which is fitted to the eye piece of the optic sheath where it is transmitted to a monitor with video recording. Endometrial curettage using a sharp ended curette after the hysteroscopic procedure starting first with the fundus, posterior wall, anterior wall, right and left lateral wall. Then, the curette was collected and placed in Formalin 10% and sent for histopathological examination.Results: The mean age of the study group was 49.95 years. The commonest pattern is premenopausal. Cases of atrophy, myomas and malignancy are mainly postmenopausal while cases of polyps and hyperplasia are mainly premenopausal. Atrophy and hyperplasia are the most common findings. Myoma is the main pathologic lesion detected by 3DUS.Convlusion: Eventhough histopathological examination of endometrial curettage is the gold standard for diagnosis or exclusion of malignancy, ultraonography is reasonably accurate, helpful and noninvasive tool for assessing uterine lesions in premenopausal andpostmenopausal women. Using 3DUS, measurement of endometrial thickness together with endometrial volume proved to be statistically important to differentiate between atrophic endometrium with values less than 5 mm thickness, 3 ml volume and other types of benign lesions (polyp, myoma and hyperplasia) (thickness, 7-20 mm and volume, 3-9 ml) and endometrial carcinoma with much higher values (thickness, 24-30 mm and volume, 41.8-97 ml) in this study.
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