Clinical Value Of Vaginal Ultrasound Combined With Hysteroscopy In The Diagnosis Of Causes Of Abnormal Uterine Bleeding During Perimenopause

Background: Perimenopausal abnormal uterine bleeding(AUB)refers to uterine bleeding that is inconsistent with normal menstrual period,menstrual volume and cycle during the period of gradual decline of ovarian function before and after menopause.Most perimenopausal AUB is caused by ovulation disorders without structural changes.In addition,endometrial lesions are also common causes of perimenopausal AUB.The more common pathological types include endometritis,endometrial hyperplasia,endometrial polyps,submucous myoma,endometrial cancer,etc.AUB is a common clinical symptom and sign of perimenopausal patients,but its clinical diagnosis and treatment are difficult due to its diverse manifestations,long or short duration,and complicated etiology.For the elderly perimenopausal patients,if the long-term irregular vaginal bleeding can cause intrauterine infection.If AUB is not diagnosed and treated in a standardized way,whether chronic or acute,it will lead to different degrees of anemia,and in severe cases,it may lead to shock,which will affect the daily life and physical and mental health of perimenopausal women to varying degrees.Therefore,it is particularly important to diagnose the cause and treat it as soon as possible.In China,transvaginal ultrasound(TVS)and hysteroscopy(HS)are the most commonly used examination methods for the diagnosis of perimenopausal AUB.The purpose of this study is to further explore the clinical value of transvaginal ultrasound combined with hysteroscopy in the diagnosis of perimenopausal AUB by analyzing the clinical data,examination results and pathological conditions of perimenopausal AUB patients,so as to provide reference for clinical diagnosis and treatment.Objective 1.To explore the common causes of abnormal uterine bleeding during perimenopause;2.To discuss the clinical value of vaginal ultrasound combined with hysteroscopy in the diagnosis of perimenopausal AUB;3.To explore the correlation between endometrial thickness and perimenopausal AUB.Methods :170 patients with perimenopausal AUB admitted to xx Hospital affiliated to Anhui Medical University from December 2021 to December 2022 were selected as the study subjects,and the case data were collected and analyzed retrospectively.The age is40-55 years old,the average age is 47.173.90 years old,the time of abnormal uterine bleeding is 2-13 months,and the average time of abnormal bleeding is 5.31.1 months.The reasons for clinical treatment include increased menstrual volume,prolonged menstrual period,prolonged cycle,shortened cycle,irregular bleeding,etc.All patients were examined by transvaginal ultrasound(TVS)and hysteroscopy(HS),and pathological examination was performed after biopsy of suspected lesions under the direct vision of hysteroscopy.The pathological diagnosis results were used as the gold standard.The examination results of TVS and HS were compared with the pathological results,and the data were statistically analyzed with spss 26.0 software to analyze and compare the clinical value of vaginal ultrasound combined with hysteroscopy in the diagnosis of perimenopausal AUB.Result:(1)Among 170 patients with perimenopausal AUB,159(93%)were benign lesions,and 11(7%)were non-benign lesions(endometrial carcinoma,atypical hyperplasia).Among benign endometrial lesions,the number of endometrial polyps was the highest in 72 cases(42%),and the rest were endometrial hyperplasia(endometrial hyperplasia without atypical hyperplasia)in 44 cases(26%),submucous myoma in 38cases(22%),and normal endometrium(proliferative,secretory,and atrophic)in 5 cases(3%).(2)There was no significant difference in the coincidence rate between vaginal ultrasound and hysteroscopy in the diagnosis of endometrial hyperplasia,endometrial cancer and atypical hyperplasia(P>0.05);In the diagnosis of endometrial polyps and submucosal myomas,the coincidence rate of hysteroscopy was significantly higher than that of vaginal ultrasound,with a statistically significant difference(P<0.05).(3)The sensitivity(71.51%)and coincidence rate(70.59%)of hysteroscopy in the diagnosis of AUB were higher than those of vaginal ultrasound(46.67%,46.47%),with no statistical difference(P>0.05).The sensitivity,specificity and coincidence rate(89.70%,80.00%,89.41%)of the combined examination of the two were significantly higher than those of vaginal ultrasound and hysteroscopy alone.(~2= 23.630,P<0.05)。(4)Compared with vaginal ultrasound or hysteroscopy alone,hysteroscopy combined with vaginal ultrasound has significantly higher specificity in diagnosis of endometrial hyperplasia and endometrial polyps(χ~2= 7.857,P<0.05;χ~2= 19.241,P<0.05)。 The sensitivity of the combined diagnosis of submucosal myoma is significantly improved(χ~2= 12.539,P<0.05)。(5)Multivariate logistic regression analysis found that the age and endometrial thickness of patients were positively correlated with the occurrence of endometrial cancer/atypical hyperplasia.The risk of endometrial cancer/atypical hyperplasia in perimenopausal AUB patients increased with age(P=0.046,OR=1.230,95%CI=0.995-1.520).With the thickening of endometrium,the risk of endometrial cancer/atypical hyperplasia in perimenopausal AUB patients also increased(P=0.014,OR=1.224,95% CI=1.041-1.440).When the cut off point value of endometrial thickness is 10.50 mm,it has the best predictive effect on endometrial cancer/atypical hyperplasia(SE: 81.80%,SP: 69.80%,AUC: 0.750,95% CI: 0.594～0.906,P<0.01).Conclusion:(1)The causes of abnormal uterine bleeding in perimenopause are mainly benign endometrial lesions,with endometrial polyps,endometrial hyperplasia,submucosal myoma and other common.(2)The age and endometrial thickness of patients are positively correlated with the incidence of endometrial cancer and atypical hyperplasia.The older the patient is,the thicker the endometrium is,and the higher the incidence rate of endometrial cancer and atypical hyperplasia is.When the cut-off point of endometrial thickness is 10.50 mm,it has 81.80% sensitivity and 69.80% specificity for patients with endometrial malignancies(AUC: 0.750,95% CI: 0.594～0.906,P<0.01).(3)Compared with vaginal ultrasound,hysteroscopy has relatively high sensitivity and specificity in the diagnosis of perimenopausal AUB.(4)Transvaginal ultrasound and hysteroscopy have different advantages in different division of labor,forming a complementary relationship.The combination of the two has higher diagnostic value,and can be reasonably used according to the needs of the disease,which is conducive to the diagnosis of perimenopausal AUB.