Vaginal ultrasound and hysteroscopy for the diagnosis of abnormal uterine bleeding

DOI: 10.12201/bmr.202308.00002

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  Abstract: Objactive: To investigate the value of vaginal ultrasound and hysteroscopy in the diagnosis of perimenopausal abnormal uterine bleeding. Methods: A total of 176 women who underwent hysteroscopy and vaginal ultrasound for abnormal uterine bleeding during perimenopause from September 2021 to March 2023 in the Second Affiliated Hospital of Xinjiang Medical University were retrospectively selected, with clear pathological diagnostic results. Results: The pathological findings were statistically different from those of vaginal ultrasound (P < 0.05), with a kappa value of 0.475, which was generally consistent. There was a statistical difference between the pathological diagnosis and hysteroscopic diagnosis (P < 0.05), and the Kappa value was 0.669, with a good agreement effect. The Kappa value of the two combined diagnoses was 0.784, with the better agreement, suggesting that the two combined diagnoses are more effective. For the diagnosis of perimenopausal abnormal uterine bleeding, the sensitivity of vaginal ultrasound was 89.7%, but the specificity of 66.7% and the negative predictive value of 46.7% were both low; the sensitivity and specificity of hysteroscopy were 94.8% and 76.2%, respectively, which were higher than those of vaginal ultrasound alone, but the negative predictive value of 66.7% was still low. The sensitivity and specificity of the two combined diagnoses were 97.4% and 81.0%, respectively, and the negative predictive value was 81.0%, both of which improved the diagnostic efficacy compared with vaginal ultrasound and hysteroscopy alone. In the etiological diagnosis of ABU due to endometrial polyps, the hysteroscopic compliance rate was 93.3%, which was higher than that of vaginal ultrasound (77.3%), and the difference was statistically significant (χ2 =7.670, P=0.006), and the detection efficacy of hysteroscopy was higher. Conclusion: Both vaginal ultrasound and hysteroscopy have some diagnostic value in the diagnosis of the etiology of perimenopausal AUB, and vaginal ultrasound is a safe and relatively inexpensive method that holds an advantage in the primary screening of the etiology of AUB. However, there is still a risk of missed diagnosis and misdiagnosis. Although hysteroscopy is expensive and less convenient, hysteroscopy combined with pathological examination can help improve the detection rate of cancer and precancerous lesions, and then clarify the cause of AUB and treat it as early as possible, which is worth promoting.

  Key words: uterus; ABU; hysteroscopy; vaginal ultrasound; abnormal uterine bleeding during perimenopause

  Submit time: 12 September 2023

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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