Pelvic ultrasound findings and its histopathological comparison in post menopausal patients presenting with uterine bleeding at Moi Teaching and Referral Hospital

Abstract

Background: Post menopausal bleeding is a common gynaecologic problem accounting for a significant number of yearly visits to the outpatient gynaecologic clinic. Indeed it is associated with significant morbidity and mortality outcomes in both the developed and developing countries. The easy availability of ultrasound as an imaging modality on most settings aids in the early diagnosis of the possible causes. Comparison with histopathology which is the gold standard will thus help to determine the diagnostic accuracy and further aid in management. Objective: To ascertain the diagnostic accuracy of pelvic ultrasonographic assessment in the diagnosis of postmenopausal bleeding in patients presenting at Moi Teaching and referral hospital. Methods: This was a descriptive cross sectional study done between July 2017 and June 2018 at Moi Teaching and Referral Hospital- Eldoret, Kenya. Consecutive sampling technique was used on consenting patients presenting with a clinical diagnosis of post menopausal bleeding. A total of 67 participants were included in the study. A structured questionnaire which had sociodemographic characteristics, the duration of bleeding and years post menopause, ultrasound findings and histopathology results was administered bythe interviewer to tha participants. Categorical data was summarized using frequencies and percentages while continuous variables were summarized using means and medians. Data analysis and statistical computing was done and results presented using tables and graphs. Results: A total of 67 participants were included in the study. The mean age was at 54.6 years with a minimum and maximum age of 48 and 62 years respectively. The years post menopause ranged from 1-15 years with a mean age of 4.6 years. Endometrial thickness greater than 5mm was diagnosed in 31 partcipants accounting for 46.2% of the population. Uterine fibroids were diagnosed in 2 patients accounting for 2% of the participants while endometrial fluid was diagnosed in 2 patients accounting for 2 % of the population. On Histological diagnosis, atrophic endometritis accounted for 48% of the cases. Endometrial hyperplasia was at 22%, endometrial carcinoma at 13%, chronic endometritis 8%, endometrial polyp 6% and Normal diagnosis at 3%. A level of agreement for malignancy calculated was found to be 57%. Recommendations: An atrophic endometrium does not rule out malignancy and follow up is necessary. Chronic endometritis in our set up is a significant finding and further studies to elucidate the cause are recommended. Conclusion: increasing endometrial thickness is associated with an increased risk in malignancy however it does not rule it out .Chronic endometricits is a significant finding in our set up on histopathological evaluation. The level of agreement between ultrasound and histopathology is low at 53 %.