title: Ultrasound assessment of endometrial cavity in perimenopausal women on oral progesterone for abnormal uterine bleeding: comparison of diagnostic accuracy of imaging with hysteroscopy-guided biopsy.
abstract: OBJECTIVE
  To investigate the effect of oral progesterone on the accuracy of imaging studies performed to detect endometrial pathology in comparison to hysteroscopy-guided biopsy in perimenopausal women on progesterone treatment for abnormal uterine bleeding.
  
  
  METHODS
  The study population comprised of women aged 40-55 years with complaints of abnormal uterine bleeding who were also undergoing oral progesterone therapy. Women with a uterus ≥ 12 weeks' gestation size, previous abnormal endometrial biopsy, cervical lesion on speculum examination, abnormal Pap smear, active pelvic infection, adnexal mass on clinical examination or during ultrasound scan and a positive pregnancy test were excluded. A transvaginal ultrasound followed by saline infusion sonography were done. On the following day, a hysteroscopy followed by a guided biopsy of the endometrium or any endometrial lesion was performed. Comparison between the results of the imaging study with the hysteroscopy and guided biopsy was done.
  
  
  RESULTS
  The final analysis included 83 patients. For detection of overall pathology, polyp and fibroid transvaginal ultrasound had a positive likelihood ratio of 1.65, 5.45 and 5.4, respectively, and a negative likelihood ratio of 0.47, 0.6 and 0.43, respectively. For detection of overall pathology, polyp and fibroid saline infusion sonography had a positive likelihood ratio of 4.4, 5.35 and 11.8, respectively, and a negative likelihood ratio of 0.3, 0.2 and 0.15, respectively.
  
  
  CONCLUSIONS
  In perimenopausal women on oral progesterone therapy for abnormal uterine bleeding, imaging studies cannot be considered as an accurate method for diagnosing endometrial pathology when compared to hysteroscopy and guided biopsy.
authors: Department of Gynaecology and Obstetrics, Institute of Post Graduate Medical Education and Research, Kolkata, India. subhankar74@gmail.com
authors: Subhankar
authors: S
authors: Dasgupta
authors: Shyamal
authors: S
authors: Dasgupta
authors: Partha Pratim
authors: PP
authors: Sharma
authors: Amitabha
authors: A
authors: Mukherjee
authors: Tarun Kumar
authors: TK
authors: Ghosh
mesh_terms: D000328:Adult; D001706:Biopsy; D004717:Endometrium / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D047648:Perimenopause; D011374:Progesterone / Q000627:therapeutic use*; D011372:Progestins / Q000627:therapeutic use*; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology
chemical_list: D011372:Progestins; D011374:Progesterone