A Clinicopathological Correlation of International Federation of Gynecology and Obstetrics's PALM–COEIN Classification of Abnormal Uterine Bleeding: Indian Scenario
A Clinicopathological Correlation of International Federation of Gynecology and Obstetrics's PALM–COEIN Classification of Abnormal Uterine Bleeding: Indian Scenario
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国际妇产科联合会 PALM-COEIN 异常子宫出血分类的临床病理学相关性：印度情况
DOI：
10.4103/jmh.jmh_128_18
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发表时间：
2019
影响因子：
1.1
通讯作者：
Mita Singh
中科院分区：
文献类型：
--
作者：
Kanika Singh;C. Agarwal;M. Pujani;Sujata Raychaudhuri;Nimisha Sharma;Varsha Chauhan;R. Chawla;Rashmi Ahuja;Mita Singh
背景资料：异常子宫出血（AUB）是影响育龄妇女的常见问题，也可能对她们的身体，社会和情感方面产生重大影响，直接影响她们的生活质量。国际妇产科联合会（FIGO）于2011年设计了一个普遍接受的命名和分类系统，即AUB的PALM-COEIN分类。本研究的目的是分析的结构（PALM）和功能（COEIN）组成部分的FIGO系统在印度的情况。材料与方法：收集300例主诉AUB的患者。根据PALM-COEIN系统，在详细的病史和临床检查后作出临床诊断。如果需要，进行额外的检查，并进行子宫内膜采样或子宫切除术，无论哪种情况。进行组织学诊断，并根据PALM-COEIN分类对每个病例进行分类。在结构性原因子宫切除术（PALM）病例中进行了临床病理学相关性分析。结果：子宫肌瘤（30%）是AUB最常见的病因，其次是子宫腺肌病（29.66%）。子宫切除病例的临床病理符合率为85.03%。AUB-L、AUB-A、AUB-M、AUB-A，L阳性病例的临床与病理诊断符合率有统计学意义（P <0.05）。然而，在48.2%的病例中，除了最初的临床诊断外，还发现了子宫腺肌病。结论：PALM-COEIN分型与临床病理有较好的相关性。该系统还考虑了临床和组织病理学上导致AUB的多种病因。然而，组织病理学仍然是建立准确诊断的基石，因为临床上可能会遗漏无特异性症状的病例。
Background: Abnormal uterine bleeding (AUB) is a common problem affecting the women of reproductive age group and may also have a significant impact on their physical, social, and emotional aspects directly affecting their quality of life. The International Federation of Gynecology and Obstetrics (FIGO) devised a universally acceptable system of nomenclature and classification, namely PALM–COEIN classification of AUB in the year 2011. The objective of the present study was to analyze the structural (PALM) and functional (COEIN) component of FIGO system in the Indian scenario. Materials and Methods: Three hundred patients with complaints of AUB were taken. A clinical diagnosis according to PALM–COEIN system was made after thorough history and clinical examination. Additional investigations if required were done, and endometrial sampling or hysterectomy was done whichever indicated. A histological diagnosis was made, and each case was allocated a category according to PALM–COEIN classification. A clinicopathological correlation was done in the hysterectomy cases for structural causes (PALM). Results: Leiomyoma (30%) was the most common cause of AUB closely followed by adenomyosis (29.66%) overall. The clinicopathological correlation in hysterectomy cases was good with concordance rate of 85.03%. The concordance between clinical and pathological diagnoses for AUB-L, AUB-A, AUB-M, and AUB-A, L was statistically significant with P < 05 in positive cases. However, additional finding of adenomyosis was diagnosed in 48.2% of the cases apart from primary clinical diagnosis. Conclusion: A good clinicopathological correlation was seen in the cases when classified according to PALM–COEIN classification. The system also provides for consideration of multiple etiologies contributing toward AUB both clinically and histopathologically. However, histopathology remains the cornerstone in establishing the accurate diagnosis as the cases without specific symptoms can be missed clinically.