DIAGNOSTIC ACCURACY OF ENDOMETRIAL CURETTAGE IN COMPARISON TO HYSTERECTOMY SPECIMENS IN PATIENTS WITH ABNORMAL UTERINE BLEEDING 

Chro Najmaddin Fattah a and Sawen Mohamed Ahmed b



Department of Obstetrics&Gynaecology, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
b Maternity Teaching Hospital, Sulaimai Directorate of Health. 
 
 
Submitted: 25/3/2019; Accepted: 29/7/2019; Published: 21/9/2019

ABSTRACT


Background 

Endometrial biopsy is an important technique used in the assessment of the Abnormal Uterine Bleeding (AUB) in women >40 years and post-menopausal women to exclude endometrial pathological abnormalities (endometrial hyperplasia and carcinoma) and confirm benign nature of the problem. Patients will be offered conservative or medical treatment and unnecessary radical surgery can be avoided.


Objectives 

To compare the diagnostic accuracy of endometrial curetting and the subsequent hysterectomy specimen histology in AUB in women > 40 years old and postmenopsal women. Also to evaluate causes of per and post-menopausal bleeding.


Patients and Methods

Endometrial sampling was obtained by dilatation and curetting (D&C) on 80 patients in premenopausal and post-menopausal women. Most of those patients were already planned for hysterectomy for abnormal uterine bleeding. Verbal consent was taken from all patients. Both samples were numbered and sent to a different histolopathologist. The histology report of both D&C and hysterectomy specimens were compared. Hysterectomy report was considered as the gold standard. 


Results

Mean duration between the curetting and hysterectomy was 5 weeks. The histology of 80 samples obtained by D&C show normal endometrium in 25 cases, endometrial hyperplasia without atypia in 36 specimens and with atypia in 4 specimens, endometrial polyps in 10, atrophic endometrium in one specimen, and endometrial carcinoma in 3 specimens. 98.8% of the samples obtained by D&C were adequate for histological examination. Our results show 77.5% of the cases concordance between the D&C and hysterectomy specimen. Accuracy for complex hyperplasia with or without atypical was 100% sensitivity, 100% specificity, followed by simple hyperplasia and benign endometrial causes of AUB condition. 


Conclusion

Abnormal Uterine Bleeding AUB increases with age, with a profound increase in incidence in premenopausal women. Endometrial hyperplasia was the most common cause of AUB. D&C is an accurate, minimally invasive procedure for detecting endometrial pathology especially for complex hyperplasia, and it has high sensitivity and specificity than those of simple hyperplasia.



KEYWORDS

Abnormal uterine bleeding, Endometrial biopsy, D&C, Hysterectomy