ROLE OF ULTRASOUND WITH DOPPLER IN DIFFERENTIATING CLINICALLY SUSPECTED CASES OF LEIOMYOMA AND ADENOMYOSIS OF UTERUS
Description
Abnormal uterine bleeding (AUB) is a common problem among women in the reproductive age group.1 It accounts for approximately 70% of the pathology in perimenopausal and post-menopausal women. AUB may occur because of hormonal imbalances or as a result of benign or malignant lesions.2 Benign myometrial lesions are common in women of reproductive age and can cause significant morbidity.3 The most common causes of uterine bleeding are adenomyosis and uterine leiomyoma. Leiomyomas are benign masses of uterine smooth muscles that can be surgically removed. Adenomyosis is an ill-defined lesion in which endometrial glands and stroma are interspersed with the myometrium, making complete removal through surgery challenging.4 Therefore, accurate preoperative diagnosis of these two conditions is critical. Imaging techniques play a crucial role in distinguishing leiomyomas from adenomyosis. Histopathology, considered a corner stone in confirming the diagnosis, remains a gold standard.4 Transabdominal/transvaginal sonography is often performed and is planned as a first line imaging modality . The ability to globally visualise the pelvic structures and organs combined with colour Doppler greatly enhances diagnostic ability.5 This study aimed to differentiate clinically suspected cases of uterine Leiomyoma and Adenomyosis using grey-scale 2D ultrasonography with color Doppler to determine its accuracy and confirm histopathological findings . Owing to similar clinical signs and symptoms, misdiagnosing one in favour of the other is not uncommon. The organic cause responsible for menstrual disorders should be ruled out to provide a final cure for a broad range of gynecological diseases and preoperative diagnosis of these two conditions is vital for patients wishing to retain their fertility.
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Study design: Observational Study. Study Period: August 2018 to August 2020. Study Setting: This study was carried out in tertiary care centres attached to the Kasturba Medical College, Mangaluru, Government Lady Goschen Hospital, and KMC Hospital Attavar. Study Population: Women reporting with complaint of Abnormal uterine bleeding in pre and perimenopausal age and clinically suspected cases of uterine Leiomyoma and Adenomyosis were selected. INCLUSION CRITERIA Patients with clinical symptoms of abnormal uterine bleeding, dysmenorrhea, abdominal mass and pelvic pain. Patients with complaints of AUB for which hysterectomy or myomectomy was the treatment of choice. EXCLUSION CRITERIA Patients for whom surgery was not the preferred treatment of choice. Confirmed cases of CA cervix, CA endometrium, and endometrial polyps. SAMPLE SIZE n= (Zα 2pq) + Zβ p1q1 + p2q2 ) (p1-p2)2 Zα= 1.96 at 95% confidence level Zβ= 1.28 at 90% power, the sample size calculated as 60. METHOD OF COLLECTION The study included 60 patients with a history of Abnormal Uterine bleeding . Clinically suspected cases of Uterine Leiomyoma and Adenomyosis were included . Institutional ethical board clearance and Informed consent was also obtained. . General and pelvic examinations and relevant investigations were performed. The clinical diagnosis was made based on the chief complaints and clinical examination. The study subjects underwent ultrasonography to confirm the clinical diagnosis. The equipment used for trans abdominal sonographic imaging was LOGIQ S7,S8,VOLUSON EXPERT730,PHILLIPS HD7,SAMSUNG 70A using a 2-5 MHz curvilinear and 6-12 MHz transvaginal transducer. Images were evaluated with respect to morphology. Sonographic images were recorded and stored for archiving purposes . A treatment plan was suggested based on radiological diagnosis. After obtaining fitness, surgery was performed individualizing the approach for each patient. Myomectomy or total hysterectomy was performed according to standard surgical protocols. The final diagnosis was made based on the histological diagnosis. The collected data were subjected to statistical analyses. The clinical diagnosis, ultrasonographic findings, and histopathological reports were compared. With this background, this study aimed to establish the accuracy of ultrasonography in diagnosing uterine leiomyoma and adenomyosis. Statistical analysis This is an observational clinical study. The Statistical Package for Social Sciences (SPSS) for Windows, Version 22.0 released 2013. Armonk, NY: IBM Corp. Chi square test was used for comparison. Independent student “t” test to compare the mean values of Doppler parameters. Sensitivity and specificity analysis was done to estimate the accuracy of USG in differentiating Leiomyoma and Adenomyosis. Significance level was set at P value of <0.05.