Investigation of transvaginal ultrasonography and hysteroscopy results in patients with abnormal uterine bleeding

Abnormal uterine bleeding has an important place among all gynecological hospital admissions. Endometrial polyps and submucous leiomyomas are two of the main factors in etiology. Comparison of the efficacy of transvaginal ultrasonography, office hysteroscopy and endometrial sampling used in diagnosis constitutes the theoretical basis for determining patient evaluation strategies. Among 666 patients who applied to Namık Kemal University Health Practice and Research Hospital Gynecology and Obstetrics Polyclinic for different reasons between September 2018 and April 2022, 367 patients who applied due to abnormal uterine bleeding were included in our study. In these patients, first transvaginal ultrasonography and then office hysteroscopy were required. The endometrial sampling results of the present patients were also collected. Pathology results were accepted as the gold standard and compared with the results of transvaginal ultrasonography and office hysteroscopy methods. There is no statistically significant correlation between office hysteroscopy findings and pathology results (p=0.001; p<0.05). According to office hysteroscopy findings, myoma was found in 9.0% (n=20) of the cases, and 36.3% (n=. 81) polyps and 54.7% (n=122) istmocele/natural, according to the pathology results; 4.9% (n=11) of the cases had myoma, 86.13% (n=192) had polyp and Ismocele/natural was found in 9.0% (n=20). According to office hysteroscopy findings, polyps were detected in only 73 of 81 cases in the pathology, while myoma was found in 2 and isthmocele/natural in 6 cases. According to the office hysteroscopy findings, isthmocele/natural was found in only 12 of 122 cases in pathology, while fibroids were found in 3 and polyps in 107. There is a statistically significant correlation between the results of office findings and the rate of myoma in pathology results (p=0.064; p>0.05); The level of agreement between the two results was found to be 0.345 (Kappa coefficient of agreement: 0.345; p=0.001; p<0.05). According to office hysteroscopy findings, myoma was detected in 9.0% (n=20) of the cases, while myoma was found in 4.9% (n=11) of the cases according to the pathology results. While myoma was detected in only 6 of the 20 cases with fibroids according to the office hysteroscopy findings, according to the pathology results, no myoma was found in 14. While myoma was not detected in only 198 of the 203 cases in which myoma was not detected according to the office hysteroscopy findings, according to the pathology results, myoma was found in 5 of them. Accordingly, the sensitivity of the test is 30.00%; specificity 97.54%; positive predictive value of 54.55%; negative predictive value was determined as 93.40% and accuracy as 91.48%. There is no statistically significant correlation between the results of office findings and the incidence of polyps in pathology results (p=0.001; p<0.05); The level of agreement between the two results was determined as 0.049 (Kappa coefficient of agreement: 0.049; p=0.224; p>0.05). While polyps were detected in 36.3% (n=81) of the cases according to office hysteroscopy findings, polyps were detected in 86.1% (n=192) of the cases according to the pathology results. According to the office hysteroscopy findings, polyps were detected in only 73 of 81 cases, according to the pathology results, and no polyps were detected in 8 of them. According to the pathology results, only 23 of the 142 cases who did not detect polyps according to office hysteroscopy findings did not have polyps, while polyps were found in 119. Accordingly, the sensitivity of the test was 90.12%; specificity 16.20%; positive predictive value of 38.02%; negative predictive value was 74.19% and accuracy was 43.05. When the results were evaluated, the compatibility of the methods with pathology was lower than the examples in the literature. The application of the methods used in this with many different people and devices, the quality of ultrasonography devices, the omission of some flat polyps, the lack of 3D, doppler or saline infusion sonography methods can be shown. After our study, we conclude that a holistic approach to methods in the evaluation of abnormal uterine bleeding is required in education and training clinics with similar conditions. Keywords: Abnornal Uterine Bleeding, Hysteroscopy, Transvaginal Ultrasonography