DOI: https://doi.org/10.53350/pjmhs22163184 ORIGINAL ARTICLE 184 P J M H S Vol. 16, No. 03, MAR 2022 Comparative Study of Diagnostic Accuracy of Ultrasonography Vs Histopathology in patients Undergoing Hysterectomy due to Uterine Pathologies SYED JOUN HUSSAIN SHAH 1 , SYEDA KHADIJA-TUL-SUGHRA MURRIUM 2 , FATIMA NAVEED 3 , MEHREEN FATIMA 4 , SYED AMIR GILANI 5 , ROMA BABAR 6 1,2 Assistant Professor (UIRSMIT) FAHS, The University of Lahore, 3 MSDU(Ultrasound), FCPS, MBBS, The University of Lahore, 4 Assistant Professor, Biostatistics, The University of Lahore, 5 MBBS,DMRD(Pak)MPH(Pak) PhD(Ultrasound) PhD(Public Health), The University of Lahore, 6 The University of Lahore, Correspondence to Dr. Roma Babar Email: romababar98@gmail.com, Tel. +92-3134536559, +92-335-1543555, +92-3227661994. ABSTRACT Background: Accurate diagnosis of uterine pathologies has become a core part when referring patients for hysterectomy. A variety of modalities can be used for the diagnosis of uterine abnormalities. Aims: To evaluate the accuracy of ultrasound in diagnosing various uterine pathologies and to compare histopathological findings with ultrasonographical findings. Methods: A cross-sectional study was conducted on 80 females who met the inclusion criteria at Department of Gynaecology, University of Lahore Teaching Hospitalover a period of 9 months from November 2020 to August 2021. The study was started after the approval of ethical committee at the University of Lahore. All the patients were enrolled in this study after signing the informed consent form. Patients preop ultra-sonographic findings and post-operative histopathology reports of the hysterectomy was analyzed and sensitivity, specificity and diagnostic accuracy of ultrasonography for uterine pathologies was calculated. Results: Majority of the patients were in 40’s age group. Most common sonographical indication for hysterectomy was fibroids, followed byadenomyosis and endometrial hyperplasia. The overall sensitivity, specificity and diagnostic accuracy values for ultrasonography in the diagnosis of uterine abnormality was satisfactory. The diagnostic accuracy of ultrasonography in detection of uterine fibroids and adenomyosis was 96.25% and 98.75%. Conclusion: Histo-pathological analysis correlates well with the pre-operative sonographical diagnosis. The diagnostic accuracy of ultrasound in detecting intrauterine pathology urges us to utilize ultrasonography as a first-line investigation in gynaecological patients. It is a valuable adjunctive to histopatholoogy with high accuracy for identification and characterization of uterine pathologies. Keywords: Ultrasound, Menorrhagia, Fibroids, Adenomyosis, Endometrial hyperplasia. INTRODUCTION Hysterectomy is ranked as the second most common surgical procedure in department of obstetrics & gynaecology, after cesarean section. 1 Its rate varies from 6.1 to 8.6 per 1000 women of reproductive ages. 2 Its incidence vary all over the world. 3 It varies from place to place on the basis of clinical factors 4 . It is estimated to be higher in developing countries than in West, the America (5.1/1000) 5 , Australia (4.7/1000) 6 , and Germany (3.6/1000) 7 . In Pakistan, the rate of hysterectomy has not been calculated but an increased frequency of hysterectomies with the passage of time in total gynecological admissions has been reported,as it is the only option if the patient do not respond to the medical treatment 8 . Hysterectomy is ranked as one of the most common elective surgical procedures worldwide. 9 The gynecologic tract is fourth most common site of cancer after breast, lungs and gastrointestinal cancers 10 . The sixth most frequent form of cancer in women worldwide is the endometrial carcinoma 11 and hysterectomy is accepted as the treatment for all malignant pelvic pathologies. 12 However, in case of benign pelvic diseases, such as uterine fibroids, endometrial polyps, adenomyosis, abnormal uterine bleeding and uterine prolapse, it is considered when other treatment options fail 13,14 . Hysterectomy is a surgery that involves the removal of the uterus 13 . On basis of resection technique, it can be total or subtotal 15 . The laparoscopic hysterectomy further includes total laparoscopic, laparoscopic supra-cervical and laparoscopic-vaginal hysterectomy 16 . Indications for hysterectomy varies from benign to malignant lesions of the female genital tract 17 . The most common gynecological indications of hysterectomy are abnormal uterine bleeding, fibroids, pelvic prolapse, premalignant and malignant lesions of the uterus, cervix, fallopian tubes or ovaries 15 . Abnormal uterine bleeding can be due to benign or malignant lesions of ----------------------------------------------------------------------------------------- Received on 13-09-2021 Accepted on 22-02-2022 uterus.In 2011, an PALM-COEIN acronym was designed by the International Federation of Gynecology and Obstetrics for the causes of abnormal uterine bleeding which includes polyps, adenomyosis, leiomyoma, hyperplasia/malignancy, coagulopathy, endometrial, ovulatory disorders, iatrogenic and not otherwise classified pathologies 18 . The nomenclature was modified further in year 2018 and it included the sub-classification of leiomyoma on the basis of ultrasound findings 19 . The National Institute for Health and Care Excellence recommends hysterectomy as the second line treatment for bleeding, when pharmacological, hormonal and less invasive procedures have failed 20 . The pelvis is divided structurally by an oblique plane from sacral promontory to the superior margin of the pubic symphysis into 2 compartments, true and the false pelvis. The true pelvis is bounded anteriorly by pubis bone and its rami, posteriorly by sacrum and coccyx, laterally by fused ilium and ischium, and inferiorly by the pelvic floor muscles. The false pelvis is bounded anteriorly by abdominal wall, posteriorly by sacrum and laterally by portions of the iliac bones 21 . The uterus is an organ responsible for functions such as menstruation, gestation, labor and delivery. Anatomically, the uterus is located in pelvis anterior to the rectum and posterior to the urinary bladder 22 . Normally the uterus and collapsed urinary bladder are present in true pelvis but as the bladder fills, the dome of the bladder extends into the false pelvis providing an acoustic window by displacing the bowel loops superiorly providing an acoustic window for trans-abdominal ultrasound imaging 21 . Ultrasound is recognized as the primary imaging modality in evaluation of female pelvis 23 . Trans-vaginal ultrasound allows visualization of the pelvic viscera in true pelvis 21 . Ultrasound modality can differentiate benign and malignant pelvic pathologies by the subjective evaluation on gray-scale ultrasound and can often make a specific diagnosis on basis of pattern recognized on the gray-scale ultrasound image. Trans-abdominal approach is