Ultrasound capabilities for predictive diagnosis and personalized minimally invasive treatment of endometrial pathology

2 Abdullaiev R.Ya., 1Bubnov R.V., 1Degtiariuk M.V., 1Mukhomor O.I.
1 Clinical Hospital ”Pheophania“ of State Affairs Department, Kyiv
2 Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine

Key words: transvaginal ultrasonography, endometrial hyperplasia, hysteroresection, predictive, personalized medicine, EPMA.

Introduction. The aim of the study was to evaluate the capabilities of Ultrasound diagnostics for minimally invasive treatment of endometrial pathology. Hysteroresection of the endometrium is considered to be the most reliable technique for the management of endometrial pathology and uterine bleeding, because it provides information on the histologic characteristics of endometrium, removal of the tissue within a prescribed depth, and coagulation of bleeding sites. Reliable visual control ensures efficiency of minimally invasive technologies in all spheres of gynecologic practices.

Materials and Methods. In 2010-2012 190 white Ukrainian gynaecological patients, the average age of 46±4.6 years, who were diagnosed the endometrial hyperplasia and were considered for invasive treatment, underwent transvaginal (TV) ultrasonography as well gynecological and general diagnostic protocol. Ultrasound scanning using TV probes 5-8 MHz frequency of ultrasound scanner HITACHI Hi Vision 7500 was carried out before, immediately after, one and six months after the intervention. We evaluated endometrium structure, thickness, margins with myometrium within TV US diagnostic protocol.

Results. In all patients hysteroresection was successful with no early complication diagnosed. In 145 patients (76%) US showed normalization of endometrial structure, smooth margins with myometrium. 45 patients (24%) the fibrotic lesions and rough margins with myometrium were revealed.
Endometrial pathology recurrence after 6 month was revealed in 4 patients (2.1%), malignancy - in 6 (3.1%) respectively. In 12 patients (6,3%) no US data were found while clinical symptoms (e.g., uteral bleeding) urged for intervention. False negative US results were noted in 6 patients (3,1%).

Conclusion . Ultrasound can be an effective method for early detection of endometrial hyperplasia and prediction outcome of minimally invasive treatment program, that makes it possible to improve the effectiveness of treatment of hyperplastic processes and improve the prevention of endometrial pathology, may be used in screening algorithms. The sensitivity, specificity, positive and negative predictive value and accuracy were 91%, 83%, 82%, 94%, and 96,79% respectively.