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Histopathological profile of Endometrial Thickness and serum LDH in Women with Post-Menopausal Bleeding
Mahnaz Syed, Mohammed Ziaur Rahman, Syed Tasnuv Sami
DOI : 10.5281/zenodo.7711013
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Introduction- Post menopause describes the period following the final menses. Despite a great increase in the life expectancy of women, the age at menopause remains remarkably constant. The life expectancy of women shows a steady rise in this era, hence women experience a longer postmenopausal phase [2]. A woman in the United States today will live approximately 30 years, or greater than a third of her life, beyond the menopause. The tumor environment is highly hypoxic so that cancer cells have an intensified anaerobic metabolism. Objective: To assess the histopathological profile of endometrial thickness and serum LDH in women with post-menopausal bleeding. Methods: This is a prospective cross-sectional study was carried out at Obstetrics and Gynecology, Sylhet MAG Osmani Medical Hospital, Sylhet, Bangladesh from January to December 2021. Total 101 women were selected for the present study after applying inclusion and exclusion criteria. The diagnostic reliability of combined serum LDH and endometrial thickness in diagnosis of endometrial carcinoma in cases of perimenopausal bleeding. All cases were subjected to full history, full clinical examination, transvaginal sonography, serum LDH and Diagnostic endometrial biopsy was taken for histopathological examination. Results: Total 101 women were selected for the present study after applying inclusion and exclusion criteria. The age of menopause was between 40 and 45 years in 15.8% of the women, 39.5% of women were between 45 and 50 years and 44.5% were above 50 years of age. It was noted that the age group of patients with postmenopausal bleeding was between 45 and 50 years in 13.9% of women, 50 to 60 years in 56.4% of the women and above the age of 60 years in 29.7% of women. It was found that TVS evaluation of endometrial thickness is not sensitive enough to detect cancer of the endometrium and therefore, could not replace histological evaluation of the endometrial tissue in women with postmenopausal bleeding. LDH level cutoff value of 430 U/L could differentiate malignant from benign lesions with a sensitivity of 80.5%, specificity 58.3%, PPV 56.7% and NPV 82.9% with a diagnostic accuracy of 66.3%. Thus, total serum LDH can be used as a good negative test using the cut-off level (430 U/L).In this study, endometrial thickness at 11.5mm cut off value showed 80.5% sensitivity, 53.3% specificity, PPV 53.3%, NPV 80.5%and diagnostic accuracy 64.4%. Combination of evaluation of endometrial thickness by TVS (with specificity of 53.3% and accuracy of 64.4%) and serum LDH (with specificity of 58.3% and accuracy of 66.3%) increase the specificity to 73.3%. also increase the accuracy to 67.3%. Conclusion: In conclusion, the measurement of serum LDH is considered another simple method to be combined with TVS if endometrial cancer is suspected. However, further studies are needed using LDH isoenzymes profile and TVS endometrial morphology.

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