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Table of Contents
LETTER TO THE EDITOR
Year : 2018  |  Volume : 7  |  Issue : 4  |  Page : 183-184

A novel non invasive screening tool for triaging endometrial pathologies in abnormal uterine bleeding: Diseases of endometrium – evaluation and risk scoring


1 Department of Obstetrics & Gynecology, Kasturba Medical College, MAHE, Manipal, Karnataka, India
2 Department of Statistics, Abeda Inamdar Senior College, Pune, Maharashtra, India

Date of Web Publication26-Sep-2018

Correspondence Address:
Dr. Deeksha Pandey
Kasturba Medical College, MAHE, Manipal - 576104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GMIT.GMIT_73_18

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How to cite this article:
Pandey D, Kummarapurugu SV, Sayyad M G. A novel non invasive screening tool for triaging endometrial pathologies in abnormal uterine bleeding: Diseases of endometrium – evaluation and risk scoring. Gynecol Minim Invasive Ther 2018;7:183-4

How to cite this URL:
Pandey D, Kummarapurugu SV, Sayyad M G. A novel non invasive screening tool for triaging endometrial pathologies in abnormal uterine bleeding: Diseases of endometrium – evaluation and risk scoring. Gynecol Minim Invasive Ther [serial online] 2018 [cited 2018 Dec 11];7:183-4. Available from: http://www.e-gmit.com/text.asp?2018/7/4/183/242303



To the Editor,

Endometrial pathologies contribute to a large proportion of abnormal uterine bleeding (AUB) during the reproductive years as well as after menopause. These pathologies can vary from variants of normal endometrium to benign, premalignant and malignant causes. Invasive sampling and subjecting it to histological diagnosis is the only confirmatory way to differentiate these causes, direct treatment and prognosticate the pathologies of the endometrium. Currently, there is a lack of highly efficacious clinically available noninvasive tests or biomarkers to differentiate these.[1] Endometrial thickness seen during transvaginal sonography (TVS) is the only parameter popularly used to define endometrial pathologies, which miserably fails to diagnose specific lesions of the endometrium.[2],[3],[4]

Hence, we propose a noninvasive scoring system that will help to prognosticate the disease even before sampling, thus reducing the anxiety for the patient until the final histology report confirms it. It may also help to reduce the burden of unnecessary samplings to the clinicians as well as decrease the burden of histological slide review for the pathologist. We call this system “diseases of endometrium– evaluation and risk scoring” (DEERS) that stands for “DEERS”.

DEERS is a combination of patient characteristics and TVS indicators to differentiate various endometrial causes of AUB [Table 1].
Table 1: Diseases of Endometrium-Evaluation and Risk Scoring System to screen endometrial pathologies by demographic characteristics and transvaginal sonography findings

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This scoring system was developed based on our experience and literature review. It includes patient characters and endometrial features that could be visualized in gray scale TVS. The scores were adjusted based on multivariate regression analysis from a pilot study conducted on 96 patients who presented with AUB and were found to have a spectrum of endometrial pathologies from normal (proliferative and secretory endometrium) to endometrial malignancy. Cut off to differentiate malignancy from a benign/normal variant of the endometrium was calculated with the help of receiver operating characteristics curve analysis. Five experts in the field individually assessed the score for content validity and modifications incorporated as per the suggestions, following detailed discussion. This proposed scoring system was then prospectively applied in a cohort of 454 (curettage/cases: 284, hysterectomy/controls: 170) women, in cases myometrial, cervical, and ovarian causes of AUB were ruled out, and only those cases where the cause were suspected to be in the endometrium were included. We found that though the efficacy of DEERS to diagnose normal variant, benign lesions, complex hyperplasia, and cancer separately was not as expected. However, the score was able to differentiate normal and benign lesions of endometrium from malignant lesions with a sensitivity of 72.2%, specificity 92.1%, positive predictive value of 44.1%, and negative predictive value of 97.5%.

The quest of sonographically visualization of endometrial appearance to device a scoring system to predict malignancy is not new. All the earlier studies, however, have focused on a very specific population of women who present with postmenopausal bleeding. This is the first study wherein a novel concept of a noninvasive scoring system to screen endometrial pathologies across ages is used. The results look promising with high to predict endometrial malignancy. With the available data, we are trying to modify this score further to make it more user-friendly without compromising its efficacy. The results of both the systems are planned to be compared in large prospective study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol 2016;34:54-65.  Back to cited text no. 1
    
2.
Dueholm M, Hjorth IM, Secher P, Jørgensen A, Ørtoft G. Reproducibility of endometrial pathologic findings obtained on hysteroscopy, transvaginal sonography, and gel infusion sonography in women with postmenopausal bleeding. J Minim Invasive Gynecol 2015;22:1036-44.  Back to cited text no. 2
    
3.
Schramm A, Ebner F, Bauer E, Janni W, Friebe-Hoffmann U, Pellegrino M, 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;296:319-26.  Back to cited text no. 3
    
4.
Wong AS, Lao TT, Cheung CW, Yeung SW, Fan HL, Ng PS, et al. Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: A retrospective cohort study. BJOG 2016;123:439-46.  Back to cited text no. 4
    



 
 
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