Investigation of risk factors for benign or malignant endometrial pathology in patients presenting with abnormal uterine bleeding
Öz
Aims: The aim of this study was to determine the risk factors associated with benign or malignant endometrial pathologies by comparing endometrial biopsy results of women presenting with abnormal uterine bleeding (AUB).
Methods: In this cross-sectional study using retrospective record review method, 100 women over 18 years of age who presented to the gynecology and obstetrics clinic with AUB and underwent endometrial biopsy were included. Age, body mass index (BMI), obstetric and gynaecological history, medical history and pathology results were recorded. Endometrial pathology results were classified as normal, benign and malignant. The effects of demographic and clinical characteristics of the patients on the risk of benign and malignant pathology were analysed.
Results: The mean age and BMI of the participants were 48.7±7.7 and 29.3±5.9 kg/m2, respectively. 59 (59.0%) of the patients were in the premenopausal period and 41 (41.0%) were in the postmenopausal period. Ultrasonographic endometrial thickness was below 8 mm in 23 patients (23.0%), between 8-11 mm in 27 patients (27.0%) and 12 mm or more in 50 patients (50.0%). Pathological results were normal in 35 patients (35%), benign pathology in 45 patients (45.0%) and malignant pathology in 20 patients (20.0%). In multivariate analyses, each 1 year increase in the age of the patients increased the risk of developing malignant endometrial pathology 1.17 times and each 1 mm increase in ultrasonographic endometrial thickness increased the risk of developing malignant endometrial pathology 1.16 times. The cut-off point for ultrasonographic endometrial thickness was found to be >12 mm. According to this cut-off point, the sensitivity and specificity of ultrasonographic endometrial thickness in predicting endometrial pathology were found to be 70% and 62.9%, respectively.
Conclusion: It is important to determine the risk factors of malignant disease in women presenting with AUB and to perform invasive methods such as endometrial biopsy in the early period in women with risk factors to affect the success of treatment directly.
Anahtar Kelimeler
Abnormal uterine bleeding endometrial biopsy benign pathology malignant pathology endometrial cancer
Kaynakça
- Jang S, Hwang S-O. Risk factors for atypical hyperplasia or endometrial cancer in premenopausal women aged ≤45 years with abnormal uterine bleeding. Eur J Obstet Gynecol Reprod Biol. 2024;302:288-293. doi:10.1016/j.ejogrb.2024.09.030
- Rezende GP, Gomes DAY, Benetti-Pinto CL. Abnormal uterine bleeding in reproductive age: a comparative analysis between the five Brazilian geographic regions. Rev Assoc Med Bras (1992). 2023;69(suppl 1):e2023S111. doi:10.1590/1806-9282.2023S111
- Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65.
- Sabre A, Serventi L, Nuritdinova D, Schiattarella A, Sisti G. Abnormal uterine bleeding types according to the PALM-COEIN FIGO classification in a medically underserved American community. J Turk Ger Gynecol Assoc. 2021;22(2):91-96. doi:10. 4274/jtgga.galenos.2021.2020.0228
- Achanna KS, Nanda J. Evaluation and management of abnormal uterine bleeding. Med J Malaysia. 2022;77(3):374-383.
- Jones ER, O’Flynn H, Njoku K, Crosbie EJ. Detecting endometrial cancer. Obstet Gynaecol. 2021;23(2):103-112.
- Vitale SG, Watrowski R, Barra F. et al. Abnormal uterine bleeding in perimenopausal women: the role of hysteroscopy and its impact on quality of life and sexuality. Diagnostics (Basel). 2022;12(5):1176. doi:10.3390/diagnostics12051176
- Brun JL, Plu-Bureau G, Huchon C. et al. Management of women with abnormal uterine bleeding: clinical practice guidelines of the French national college of gynaecologists and obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2023;288:90-107. doi:10.1016/j.ejogrb.2023.07.001
- van Maldegem LDPR, van der Zande JA, van Werkhoven LA, et al. Recurrent postmenopausal bleeding: pathological findings and predictive factors: a multicenter, prospective, observational study. Acta Obstet Gynecol Scand. 2024;103(7):1283-1291. doi:10. 1111/aogs.14851
- Van Den Bosch T, Verbakel JY, Valentin L, et al. Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding. Ultrasound Obstet Gynecol. 2021;57(1):164-172. doi:10.1002/uog.22109
- Su D, Li L, Zhong M, Xia Y. Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis. Ann Palliat Med. 2021;10(10):10840-10848. doi:10.21037/apm-21-2516
- Zhang CY, Li H, Zhang S, et al. Abnormal uterine bleeding patterns determined through menstrual tracking among participants in the Apple Women’s Health Study. Am J Obstet Gynecol. 2023;228(2):213.e1-213.e22. doi:10.1016/j.ajog.2022.10.029
- Leal CRV, Vannuccini S, Jain V, et al. Abnormal uterine bleeding: the well-known and the hidden face. J Endometr Uter Disord. 2024;6:100071. doi:10.1016/j.jeud.2024.100071
- Karena ZV, Mehta AD, Vikani S. Palm-COEIN classification for abnormal uterine bleeding: a study of its practical applicability and distribution of causes. J South Asian Fed Obstet Gynaecol. 2023;14(6):681-684.
- Amiri M, Bidhendi-Yarandi R, Fallahzadeh A, et al. Polikistik over sendromlu kadınlarda endometrial, over ve meme kanseri riski: sistematik bir inceleme ve meta-analiz. Int J Reprod Biomed (Yazd). 2022;20(11):893-914. doi:10.18502/ijrm.v20i11.12357
- Tsuji S, Nobuta Y, Hanada T, et al. Prevalence, definition, and etiology of cesarean scar defect and treatment of cesarean scar disorder: a narrative review. Reprod Med Biol. 2023;22(1):12532. doi:10.1002/rmb2.12532
- Jewson M, Purohit P, Lumsden MA. Progesterone and abnormal uterine bleeding/menstrual disorders. Best Pract Res Clin Obstet Gynaecol. 2020;69:62-73.
- Husain S, Al Hammad RS, Alduhaysh AK, et al. Pathological spectrum of endometrial biopsies in Saudi women with abnormal uterine bleeding: a retrospective study of 13-years. Saudi Med J. 2021;42(3):270-279. doi:10.15537/smj.2021.42.3.20200814
- Clarke MA, Long BJ, Sherman ME, et al. Risk assessment of endometrial cancer and endometrial intraepithelial neoplasia in women with abnormal bleeding and implications for clinical management algorithms. Am J Obstet Gynecol. 2020;223(4):549.e1-549.e11.
- Harvey SV, Wentzensen N, Bertrand K, et al. Associations of life course obesity with endometrial cancer in the Epidemiology of Endometrial Cancer Consortium (E2C2). Int J Epidemiol. 2023;52(4):1086-1099. doi:10.1093/ije/dyad046
- McVicker L, Cardwell CR, Edge L, et al. Survival outcomes in endometrial cancer patients according to diabetes: a systematic review and meta-analysis. BMC Cancer. 2022;22(1):427. doi:10. 1186/s12885-022-09510-7
- Main C, Chen X, Zhao M, et al. Understanding how pregnancy protects against ovarian and endometrial cancer development: fetal antigens may be involved. Endocrinology. 2022;163(11):bqac141.doi:10.1210/endocr/bqac141
- Keenahan L, Bercaw-Pratt JL, Adeyemi O, et al. Rates of intrauterine device expulsion among adolescents and young women. J Pediatr Adolesc Gynecol. 2021;34(3):362-365. doi:10. 1016/j.jpag.2020.11.003
- Raja RS, Ramakrishnan KK, Sekar A, Subbiah M, Natarajan P. Comparison of transabdominal sonography and transvaginal sonography in evaluation of endometrial thickness in the setting of abnormal uterine bleeding. East J Med Sci. 2023;8(1):15-19.
- American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 426: the role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. Obstet Gynecol. 2009;113(2 Pt 1):462-464.
- Jain V, Chodankar RR, Maybin JA, Critchley HOD. Uterine bleeding: how understanding endometrial physiology underpins menstrual health. Nat Rev Endocrinol. 2022;18(5):290-308. doi:10.1038/s41574-021-00629-4
- Kılınç H, Cengiz H, Kaya C, Ekin M, Yaşar L. Endometrial patolojilerin değerlendirilmesinde transvajinal ultrasonografi ile ofis histeroskopinin karşılaştırılması. Yeni Tıp Derg. 2012; 29(1):23-26.
- Saccardi C, Spagnol G, Bonaldo G, et al. New light on endometrial thickness as a risk factor of cancer: what do clinicians need to know? Cancer Manag Res. 2022;14:1331-1340. doi:10.2147/CMAR.S294074
- Shen D, Mao W, Liu T, et al. Sedentary behavior and incident cancer: a meta-analysis of prospective studies. PLoS One. 2014; 9(8):e105709.
- Kumari P, Gaikwad HS, Nath B. Endometrial cut off thickness as predictor of endometrial pathology in perimenopausal women with abnormal uterine bleeding: a cross-sectional study. Obstet Gynecol Int. 2022;2022:5073944. doi:10.1155/2022/5073944
Öz
Kaynakça
- Jang S, Hwang S-O. Risk factors for atypical hyperplasia or endometrial cancer in premenopausal women aged ≤45 years with abnormal uterine bleeding. Eur J Obstet Gynecol Reprod Biol. 2024;302:288-293. doi:10.1016/j.ejogrb.2024.09.030
- Rezende GP, Gomes DAY, Benetti-Pinto CL. Abnormal uterine bleeding in reproductive age: a comparative analysis between the five Brazilian geographic regions. Rev Assoc Med Bras (1992). 2023;69(suppl 1):e2023S111. doi:10.1590/1806-9282.2023S111
- Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65.
- Sabre A, Serventi L, Nuritdinova D, Schiattarella A, Sisti G. Abnormal uterine bleeding types according to the PALM-COEIN FIGO classification in a medically underserved American community. J Turk Ger Gynecol Assoc. 2021;22(2):91-96. doi:10. 4274/jtgga.galenos.2021.2020.0228
- Achanna KS, Nanda J. Evaluation and management of abnormal uterine bleeding. Med J Malaysia. 2022;77(3):374-383.
- Jones ER, O’Flynn H, Njoku K, Crosbie EJ. Detecting endometrial cancer. Obstet Gynaecol. 2021;23(2):103-112.
- Vitale SG, Watrowski R, Barra F. et al. Abnormal uterine bleeding in perimenopausal women: the role of hysteroscopy and its impact on quality of life and sexuality. Diagnostics (Basel). 2022;12(5):1176. doi:10.3390/diagnostics12051176
- Brun JL, Plu-Bureau G, Huchon C. et al. Management of women with abnormal uterine bleeding: clinical practice guidelines of the French national college of gynaecologists and obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2023;288:90-107. doi:10.1016/j.ejogrb.2023.07.001
- van Maldegem LDPR, van der Zande JA, van Werkhoven LA, et al. Recurrent postmenopausal bleeding: pathological findings and predictive factors: a multicenter, prospective, observational study. Acta Obstet Gynecol Scand. 2024;103(7):1283-1291. doi:10. 1111/aogs.14851
- Van Den Bosch T, Verbakel JY, Valentin L, et al. Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding. Ultrasound Obstet Gynecol. 2021;57(1):164-172. doi:10.1002/uog.22109
- Su D, Li L, Zhong M, Xia Y. Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis. Ann Palliat Med. 2021;10(10):10840-10848. doi:10.21037/apm-21-2516
- Zhang CY, Li H, Zhang S, et al. Abnormal uterine bleeding patterns determined through menstrual tracking among participants in the Apple Women’s Health Study. Am J Obstet Gynecol. 2023;228(2):213.e1-213.e22. doi:10.1016/j.ajog.2022.10.029
- Leal CRV, Vannuccini S, Jain V, et al. Abnormal uterine bleeding: the well-known and the hidden face. J Endometr Uter Disord. 2024;6:100071. doi:10.1016/j.jeud.2024.100071
- Karena ZV, Mehta AD, Vikani S. Palm-COEIN classification for abnormal uterine bleeding: a study of its practical applicability and distribution of causes. J South Asian Fed Obstet Gynaecol. 2023;14(6):681-684.
- Amiri M, Bidhendi-Yarandi R, Fallahzadeh A, et al. Polikistik over sendromlu kadınlarda endometrial, over ve meme kanseri riski: sistematik bir inceleme ve meta-analiz. Int J Reprod Biomed (Yazd). 2022;20(11):893-914. doi:10.18502/ijrm.v20i11.12357
- Tsuji S, Nobuta Y, Hanada T, et al. Prevalence, definition, and etiology of cesarean scar defect and treatment of cesarean scar disorder: a narrative review. Reprod Med Biol. 2023;22(1):12532. doi:10.1002/rmb2.12532
- Jewson M, Purohit P, Lumsden MA. Progesterone and abnormal uterine bleeding/menstrual disorders. Best Pract Res Clin Obstet Gynaecol. 2020;69:62-73.
- Husain S, Al Hammad RS, Alduhaysh AK, et al. Pathological spectrum of endometrial biopsies in Saudi women with abnormal uterine bleeding: a retrospective study of 13-years. Saudi Med J. 2021;42(3):270-279. doi:10.15537/smj.2021.42.3.20200814
- Clarke MA, Long BJ, Sherman ME, et al. Risk assessment of endometrial cancer and endometrial intraepithelial neoplasia in women with abnormal bleeding and implications for clinical management algorithms. Am J Obstet Gynecol. 2020;223(4):549.e1-549.e11.
- Harvey SV, Wentzensen N, Bertrand K, et al. Associations of life course obesity with endometrial cancer in the Epidemiology of Endometrial Cancer Consortium (E2C2). Int J Epidemiol. 2023;52(4):1086-1099. doi:10.1093/ije/dyad046
- McVicker L, Cardwell CR, Edge L, et al. Survival outcomes in endometrial cancer patients according to diabetes: a systematic review and meta-analysis. BMC Cancer. 2022;22(1):427. doi:10. 1186/s12885-022-09510-7
- Main C, Chen X, Zhao M, et al. Understanding how pregnancy protects against ovarian and endometrial cancer development: fetal antigens may be involved. Endocrinology. 2022;163(11):bqac141.doi:10.1210/endocr/bqac141
- Keenahan L, Bercaw-Pratt JL, Adeyemi O, et al. Rates of intrauterine device expulsion among adolescents and young women. J Pediatr Adolesc Gynecol. 2021;34(3):362-365. doi:10. 1016/j.jpag.2020.11.003
- Raja RS, Ramakrishnan KK, Sekar A, Subbiah M, Natarajan P. Comparison of transabdominal sonography and transvaginal sonography in evaluation of endometrial thickness in the setting of abnormal uterine bleeding. East J Med Sci. 2023;8(1):15-19.
- American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 426: the role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. Obstet Gynecol. 2009;113(2 Pt 1):462-464.
- Jain V, Chodankar RR, Maybin JA, Critchley HOD. Uterine bleeding: how understanding endometrial physiology underpins menstrual health. Nat Rev Endocrinol. 2022;18(5):290-308. doi:10.1038/s41574-021-00629-4
- Kılınç H, Cengiz H, Kaya C, Ekin M, Yaşar L. Endometrial patolojilerin değerlendirilmesinde transvajinal ultrasonografi ile ofis histeroskopinin karşılaştırılması. Yeni Tıp Derg. 2012; 29(1):23-26.
- Saccardi C, Spagnol G, Bonaldo G, et al. New light on endometrial thickness as a risk factor of cancer: what do clinicians need to know? Cancer Manag Res. 2022;14:1331-1340. doi:10.2147/CMAR.S294074
- Shen D, Mao W, Liu T, et al. Sedentary behavior and incident cancer: a meta-analysis of prospective studies. PLoS One. 2014; 9(8):e105709.
- Kumari P, Gaikwad HS, Nath B. Endometrial cut off thickness as predictor of endometrial pathology in perimenopausal women with abnormal uterine bleeding: a cross-sectional study. Obstet Gynecol Int. 2022;2022:5073944. doi:10.1155/2022/5073944
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Tıp Eğitimi |
| Bölüm | Research Articles |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Ekim 2024 |
| Gönderilme Tarihi | 9 Ağustos 2024 |
| Kabul Tarihi | 18 Ekim 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 6 Sayı: 6 |
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