Histopathological Spectrum of Endometrial Lesions in Abnormal Uterine Bleeding and It’s Association with Endometrial Thickness

Introduction: Endometrial sampling is a simple and cost-effective procedure for histological evaluation in Abnormal uterine bleeding (AUB), however the threshold for performing endometrial sampling based on endometrial thickness is found to be variable. Objectives: To evaluate the histopathological patterns of endometrium with endometrial thickness in women with AUB and to determine the threshold of endometrial thickness for performing endometrial biopsy. Material and methods: This was a cross-sectional observational study conducted in a tertiary care centre in Karnataka over a period of 1 year from January 2023 to December 2023. Clinical, histopathological, and radiological data were retrieved for reproductive, peri and postmenopausal groups. The data were analysed using Statistical Package for the Social Sciences (SPSS) version. Categorical values were evaluated with Pearson’s Chi-square test. Results: A total of 232 cases were included in the study, reproductive (n=85), peri (n=106) and postmenopausal (n=41) groups. In perimenopausal group (n=106), the mean thickness was 9.8 ±5.41 mm with most common pattern being proliferative pattern (27.3%). In the post-menopausal age group (n=41), mean thickness was 10.8± 7.6mm. Cut off endometrial thickness for occurrence of abnormal histopathological pattern for peri menopausal age group was 9.8mm (p value = 0.0004). The sensitivity, specificity, positive predictive value, and negative predictive value were found to be 85%, 46%, 68% and 70% respectively. In the postmenopausal age group, cut off value was 5mm (p value =0.0257). The sensitivity and specificity were found to be 100% and 49% respectively. Conclusion: Endometrial sampling is an invasive approach, correlation with clinical examination, ultrasonography and histopathological evaluation play a pivotal role in accurate diagnosis and patient management. Keywords: Postmenopause, Uterine bleeding, Radiology, Perimenopause, Endometrium, Ultrasound