Comparison of Fractional D&C with uterine Pathology in Determining the Causes of Abnormal Uterine Bleeding in women of Premenopausal and Postmenopausal Stage

Abnormal uterine bleeding in pre and post menopausal period may be caused by of benign or malignant causes in endometrium or endocervix that need careful investigations by multiple diagnostic methods such as dilatation and curettage, diagnostic hysterectomy, endometrial biopsy and tran’s vaginal biopsy. The aim of this study was to evaluate the diagnostic value of fractional D&C in assessment of abnormal uterine bleeding. Methods and Materials: In this descriptive study 156 women between 35 to 7 years old were admitted because of abnormal uterine bleeding after ruling out pregnancy, hormonal disorder and coagulation disorders. The study was done in 2002 and patients underwent fractional D&C and then hysterectomy because of histological findings or persistence of symptoms. The results were compared with histological findings of the hysterectomy specimen (gold standard) and were evaluated for sensitivity, specificity, positive and negative predictive values of these methods. In all focal and diffuse uterine disease fractional D&C was 29.5% sensitive and 88.2% specific and its positive predictive value was 76.5% and its negative predictive value was 49.2%. In endometrial pathologies (such as hyperplasia and …) its sensitivity was 68.4% and its specificity was 98.3% and positive and negative predictive value were 92.9% and 90.6% respectively. 100% of lyomyoma and adenomyosis cases, 66.6% of endometrial polyp cases and 2.5% of different endometrial hyperplasia cases were miss-diagnosed in fractional D&C. Fractional D&C is not a reliable method for diagnosis of focal uterine diseases such as myoma or adenomyosis and also endometrial polyps but it is useful in the diagnosis of endometrial hyperplasia. Based on to the costs of fractional D& C compared with other diagnostic methods and its pathologic results, routine use of this method in evaluation of AUB is not recommended.