Diagnostic accuracy of uterine fluid lactate dehydrogenase isoenzyme activity profile and vaginal ultrasound in detecting endometrial cancer in women with postmenopausal bleeding.

OBJECTIVE

To evaluate the diagnostic accuracy of lactate dehydrogenase (LD) isoenzyme activity profile in uterine fluid and transvaginal ultrasound (TVS) in detection of endometrial cancer in women with postmenopausal bleeding.

STUDY

DESIGN

Prospective controlled clinical study.

METHODS

One hundred twenty postmenopausal women with one or more episode of vaginal bleeding were studied. Endometrial thickness was classified as >5 mm or <5 mm on TVS. LD isoenzyme activity profile was described as normal or abnormal. LD isoenzyme profile was subsequently related to histopathological diagnosis.

RESULTS

Endometrial carcinoma was found in 10 out of 120 patients (8.3%). Sixty-seven patients (56%) were found to have endometrium >5-mm thickness on TVS. LD isoenzyme activity profile was abnormal in 22 (18.3%) cases. Histopathological diagnosis in these cases revealed 10 endometrial cancer and 12 benign endometrium. LD isoenzyme activity profile has 100% sensitivity, 90.1% specificity, 45.4% positive predictive value, 100% negative predictive value, and 88.6% accuracy.

CONCLUSION

LD isoenzyme profile of uterine fluid could be added as a marker for endometrial cancer in postmenopausal women with vaginal bleeding and endometrial thickness >5 mm on transvaginal ultrasound. Uterine fluid sampling is easy, highly reliable, minimally invasive, with high patient compliance, and can be performed as an office procedure. Furthermore, this method is insensitive to endometrial thickness, amount of sample, sampling device, and dilution.