Study Of The Value Of Transvaginal Ultrasound Combined With Bleeding Mode For The Cause Of Abnormal Uterine Bleeding

Objective: Through the combination of transvaginal ultrasound,bleeding mode,hysteroscopy and pathological diagnosis,to explore the value of transvaginal ultrasound combined with bleeding mode in predicting the etiology of abnormal uterine bleeding.Methods: I has collected premenopausal patients who underwent hysteroscopy in our hospital due to abnormal uterine bleeding(AUB)or abnormal ultrasound results from January 2017 to December 2018.Collected the general condition of the patient(age,height,weight,gravidity,parity),menstruation(menophania dysmenorrhea,bleeding mode),previous history(history of DM,HBP,thyroid disease,PCOS)and transvaginal ultrasound results,hysteroscopy results,pathological results.The final diagnosis is based on hysteroscopy results combined with pathological results.inclusion criteria: patients with endometrial polyps,endometrial hyperplasia and carcinoma,normal menstrual cycle endometrium.Grouped according to patient bleeding mode and final diagnosis.Result: 1.A total of 437 patients,120 cases were finally diagnosed as normal menstrual cycle endometrium.178 cases were finally diagnosed as endometrial polyps,whose bleeding mode was most common inter-menstrual bleeding.139 cases were finally diagnosed as endometrial hyperplasia and carcinoma,whose bleeding mode was most common irregular bleeding.2.A total of 437 patients.The bleeding mode mainly included: 112 cases of irregular bleeding,67 cases of inter-menstrual bleeding,66 cases of prolong with or without hypermenorrhea,61 cases of oligomenorrhea,12 cases of polymenorrhea and 10 cases of hypomenorrhea.109 cases were found due to abnormal ultrasound or prepregnancy examination.3.112 patients with irregular bleeding,the final diagnosis of endometrial hyperplasia and carcinoma accounted for 75.9%,endometrial polyps accounted for 16.1%,the normal menstrual cycle endometrium accounted for 8.04%.67 patients with inter-menstrual bleeding,the final diagnosis of endometrial polyps accounted for 68.7%,the normal menstrual cycle endometrium accounted for 19.4%,and the endometrial hyperplasia and carcinoma accounted for 11.9%.66 patients with 66 cases of prolong with or without hypermenorrhea,the final diagnosis of endometrial polyps accounted for 50.0%,endometrial hyperplasia and carcinoma accounted for 25.8%,and normal endometrial cycle accounted for 24.2%.Of the 61 patients with menstrual thinning,the final diagnosis of endometrial polyps accounted for 39.3%,the normal menstrual cycle endometrium accounted for 31.1%,and the endometrial hyperplasia and carcinoma accounted for 29.5%.There were 109 cases of abnormal ultrasound results or pre-pregnancy examination without abnormal bleeding.The final diagnosis of the normal menstrual cycle endometrium accounted for 46.8%,endometrial polyps accounted for 45.9%,endometrial hyperplasia and carcinoma accounted for 7.3%.4.For patients with normal menstrual cycle endometrium,endometrial thickness less than 9.55 mm,echo is uniform,there are three-line sign exclude endometrial-related lesions.The sensitivity,specificity,PPV,NPV,and Youden index were 82.35%,95.83%,77.78%,96.84%,and 0.78,respectively.For patients with EP.With intermenstrual bleeding to predict EP,sensitivity,specificity,PPV,NPV,Youden index were 31.91%,92.59%,75.00%,66.14%,0.25.The results of transvaginal ultrasound show local echo unevenness and there is three-line sign to predict EP,sensitivity,specificity,PPV,NPV,and Youden index were 93.85%,67.39%,80.26%,88.57%,and 0.61,respectively.inter-menstrual bleeding combined with transvaginal ultrasound,the sensitivity,specificity,PPV,NPV and Youden index to predict EP were 86.96%,87.88%,83.33%,90.63% and 0.75,respectively.In terms of endometrial hyperplasia and carcinoma: the sensitivity,specificity,PPV,NPV,and Youden index of the bleeding mode for irregular bleeding were 64.89%,89.63%,81.33%,78.57%,and 0.55,respectively.Transvaginal ultrasound showed that the endometrial thickness was ≥14.5mm,the uterine cavity echo increased and there was no three-line sign.The sensitivity,specificity,PPV,NPV and Youden index were 95.56%,91.67%,87.76%,97.06% and 0.87,respectively.The sensitivity,specificity,PPV,NPV,and Yoden index of bleeding mode combined with transvaginal ultrasound were 96.67%,98.39%,96.67%,98.39%,and 0.95,respectively.Conclusion: 1.The most common bleeding mode of endometrial polyps is inter-menstrual bleeding.Common ultrasound result is local endometrial uneven echo,clear high echogenic mass in uterine cavity,transvaginal ultrasound combined with bleeding mode can predict accurately.2.The most common bleeding mode of endometrial hyperplasia and carcinoma is irregular bleeding.Common ultrasound result is endometrial thickening + high echo and no obvious three-line sign.Transvaginal ultrasound combined with bleeding mode for endometrial hyperplasia and cancer has a high clinical diagnostic value.3.Transvaginal ultrasound combined with bleeding mode can accurately separate high-risk and low-risk patients,we can give further examination of high-risk patients,timely diagnosis and treatment,to avoid disease progression;And avoid unnecessary invasive examinations for low-risk patients,reduce patient suffering and medical waste.