| Background and objective: Abnormal uterine bleeding(AUB) is one of the most common clinical disease of gynecological disease, divided into organic diseases and functional diseases, which is difficult to identify the etiological diagnosis by routine gynecological examination and curettage. The mature clinical ultrasonic technology and hysteroscopy technology can reflect the uterine cavity lesions more clearly and directly, which improve the diagnostic accuracy of AUB. Objective: To summarize the clinical characteristics and age distribution of AUB; To analyze the clinical value of hysteroscopy technology and transvaginal ultrasonography(TVS) in etiological diagnosis of AUB.Method: Research object and data: 208 patients of AUB who were diagnosed by the east end of the second hospital of Hebei Medical University were chosen during August 2013 to December 2014, whose ages were among 19 to 77 year-old, and all of the patients had sexual life. TVS was performed before hysteroscopy technology. At the same time, the general statistical data, the results of TVS and the diagnosis of hysteroscopy were recorded.Results:1 The age distribution of 208 patients of AUB: 9.1% was younger than 25 year-old, 28.4% was among the ages of 26 to 35, 38.9% was among the ages of 36 to 45, 18.3% was among the ages of 46-55, 4.3% was among the ages of 56-65, 1% was older than 66 year-old.2 The clinical features of AUB in statistics: irregular menstrual cycle(20.2%), vaginal dripping bleeding(39.4%), menostaxis(10.1%), menorrhagia(18.8%), contact bleeding(1.9%), postmenopausal bleeding(9.6%).The classification of etiology: Endometrial polyps(EP) had 79 cases(38.0%), proliferative/secretory phase endometrium had 39 cases(18.8%), endometrial hyperplasia had 56 cases(26.9%), submucous myoma had 24 cases(11.6%), endometrial cancer had 7 cases(3.7%), endometrial tuberculosis had 3 cases(1.4%), endometrial cancer and precancerous lesions(atypical hyperplasia of endometrium) had 9 cases(4.3%).3 The etiology of abnormal uterine bleeding under the hysteroscopy and pathology of coincidence rate comparison: endometrial polyp, endometrium hyperplasia, submucous myoma, endometrial tuberculosis, coincidence rate were 70.5%, 52.5%, 90.9% and 100% respectively; 4 cases of hysteroscopy in the diagnosis of endometrial cancer pathology confirmed completely, the sensitivity was 57.14%, specificity of 100%, positive predictive value was 100% and negative predictive value was 98.0%; 2 cases of hysteroscopy in the diagnosis of all endometritis pathological diagnosis of endometrial hyperplasia.4 The TVS results compared with histopathological results: there were 197 diagnosed endometrial lesions by TVS, 169 cases were confirmed by pathology. The accuracy of TVS in the diagnosis of endometrial polyps, endometrial hyperplasia, submucous myoma were 77.8%, 51.9% and 77.8% respectively; Ultrasound diagnosis uterine placeholder 22 cases, the largest proportion was endometrial polyps: 12 cases(54.5%); 6 endometrial hyperplasia in the diagnosis of endometrial lesions was the largest proportion.5 The accuracy hysteroscopy results and the accuracy of TVS in comparison: hysteroscopy in the diagnosis of endometrial lesions of the sensitivity of 98.2%, specificity of 20.5%, positive predictive value, negative predictive value of 84.3%, 72.7%, TVS for endometrial lesions of the sensitivity of 92.9%, specificity of 7.7%, positive predictive value, negative predictive value of 81.3%, 20.0%. Hysteroscopy in diagnosis of endometrial lesions with TVS, the sensitivity and negative predictive value had statistically significant difference(P <0.05).6 Hysteroscopy examination and vaginal ultrasound accuracy comparison of endometrial polyps:Hysteroscopy in the diagnosis of endometrial polyps of the sensitivity, specificity, positive predictive value, negative predictive value were 93.7%, 76%, 70.5%, 95.1%, vaginal ultrasound detecting intrauterine lesions of sensitivity, specificity, positive predictive value, negative predictive value were 53.2%, 90.7%, 77.8% and 76.0%, respectively. Sensitivity, specificity, and negative predictive value was statistically difference between hysteroscopy and TVS(P<0.001), while there was no statistically significant difference positive predictive value(P>0.05). Pure hysteroscopy in the diagnosis of EP and pathology results coincidence rate was 70.5%(74/105), ultrasonic combined hysteroscopy diagnosis and pathology results coincidence rate was 96.2%(50/52), coincidence rate comparing differences between two groups was statistically significant(P <0.001).7 The sensitivity of hysteroscopy in the diagnosis of endometrial hyperplasia was 57.1%, the sensitivity of the vaginal ultrasound in the diagnosis of endometrial hyperplasia was 75.0%, in comparing the two groups had significant difference(P<0.05). Hysteroscopy in the diagnosis of submucous myoma coincidence rate was 90.9%, vaginal ultrasound in the diagnosis of submucous myoma coincidence rate was 88.9%, no statistically significant difference between them(P>0.05).8 In pathological diagnosis of 208 patients with AUB, there were 29 cases of normal endometrium, the average thickness of endometrium was 0.86 ±0.51 mm, the range was 0.26~3.29 mm. 79 patients with endometrial polyp average thickness of endometrium were 1.13±0.56 mm, endometrium thickness range was between 0.22~3.51 mm, 38 endometrial hyperplasia of endometrium thickness 1.18±0.46 mm, endometrium thickness range was between 0.38~2.48 mm. Endometrial polyps group compared with normal endometrium group had significant difference(P=0.013), endometrial hyperplasia and normal endometrium group compared with significant differences(P=0.012), endometrial polyps group compared with endometrial hyperplasia group had no statistically significance(P>0.05).Conclusion:1 The causes of AUB mainly are benign lesions, which are EP and endometrial hyperplasia mainly.2 TVS has high sensitivity and precise positive predictive value in diagnosis of uterine cavity lesions. But for the cause of parting specificity under hysteroscopy examination, which is an useful diagnostic method for screening of the endometrium lesions in AUB.3 Hysteroscopy has higher sensitivity and more precise positive predictive value in the diagnosis of the cause of AUB than TVS, as well as is invaluable in the treatment, that has clinical significance in diagnosis and treatment of AUB by combined with TVS. |
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