Structured imaging technique in the gynecologic office for the diagnosis of abnormal uterine bleeding

Area of Science:

• Gynecology
• Diagnostic Imaging
• Reproductive Medicine

Background:

• Abnormal uterine bleeding (AUB) diagnosis requires identifying the cause, often categorized by the PALM-COEIN system.
• Structural abnormalities (PALM causes) are typically the initial focus in gynecologic evaluations for AUB.
• Current diagnostic methods include ultrasonography, endometrial sampling, and hysteroscopy, often used in combination.

Purpose of the Study:

• To describe a structured transvaginal ultrasound (TVS) protocol for simplified AUB diagnosis in routine gynecologic practice.
• To guide the determination of when additional invasive investigations are necessary for AUB.
• To propose diagnostic setups for premenopausal women using the PALM-COEIN system and for postmenopausal women for endometrial cancer screening.

Main Methods:

• Detailed description of a simple, structured transvaginal ultrasound technique.
• Identification of common endometrial and myometrial abnormalities and their ultrasound features.
• Outline of criteria for incorporating Magnetic Resonance Imaging (MRI) when indicated.

Main Results:

• The structured TVS approach aims to simplify the diagnostic process for AUB.
• It facilitates the classification of AUB according to the PALM-COEIN system.
• The protocol helps differentiate between structural and non-structural causes, guiding further management.

Conclusions:

• Structured transvaginal ultrasound is a valuable tool for the initial diagnosis and classification of abnormal uterine bleeding.
• This method can streamline gynecologic practice, reducing the need for immediate invasive procedures.
• Future applications include rapid screening for endometrial cancer in postmenopausal women.