Clinico-pathological evaluation and etiological stratification of chronic AUB patients based on PALM-COEIN classification: A prospective study in tertiary care center of Nalgonda District

Abstract

Context: Abnormal uterine bleeding (AUB) is a common crippling gynaecological condition with vast financial implications. A structured approach for establishing the cause using the FIGO defined PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy (and hyperplasia), Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic and Not otherwise classified) classification system will facilitate accurate diagnosis and inform treatment options. Aims and objectives: 1. Clinico-pathological evaluation of patients presenting with chronic AUB. 2. Etiological stratification of patients with chronic AUB in accordance to PALM-COEIN Classification.3. To determine frequency of various uterine histopathological findings and their associated etiologies in the population of Nalgonda district. Settings and Design:The present study was a cross-sectional prospective study conducted at the Department of pathology and Department of Obstetrics and Gynecology, Kamineni Institute of Medical Sciences, Narketpalli over a period of 2 years starting from June 2016 to June 2018. Methods and Material: The study population included 188 cases of Chronic AUB. Specimens analysed were: 1. endometrial biopsy obtained by dilatation and curettage. 2. Hysteroscopy guided biopsy 3. Hysterectomy specimens. Histopathological evaluation of specimens was done and reported in accordance with PALM-COEIN classification. Results: The commonest Age group involved was perimenopausal group (41-50) constituting (39.4%). Multiparous women most commonly presented with AUB accounting for 44.1% of all cases. Menorrhagia is the most common clinical presentation in reproductive age group (50.6%) and perimenopausal women (39.2%). Post-menopausal bleeding (36.0%) is commonest presentation in Post- menopausal age-group of AUB patients. Proliferative endometrium is the most common histological finding in reproductive age group (44.9%) and perimenopausal women (33.8%). Leiomyomas are the most common presentation is Post-menopausal women (32%). 4 Patients in the Post-menopausal Age group presented with Endometrioid Adenocarcinoma. According to PALM-COEIN classification AUB-E is the most common etiologic factor across all age groups. Non-structural causes account for 54.8% of AUB cases and among 45.2% of structural causes, Simple cystic hyperplasia is the most common histological finding. Conclusions: AUB is a common and debilitating condition with high direct and indirect costs. Histopathological evaluation is the gold standard tool in the evaluation of the patients with Chronic AUB. A structured approach to establishing the cause using the FIGO PALM-COEIN classification system will facilitate accurate diagnosis and inform treatment options.