Role of Serum Lactate Dehydrogenase (LDH) and endometrial thickness in the detection of endometrial carcinoma in perimenopausal bleeding
Introduction: Postmenopausal bleeding (PMB) refers to any uterine bleeding in a menopausal patient (other than the expected cyclic bleeding that occurs in patients taking combined (ie, estrogen-progestin), cyclic, postmenopausal hormone therapy. Perimenopausal bleeding (PMB) occurs in approximately 3% of women and it is the usual presenting symptom of endometrial carcinoma in approximately 93% of cases. Objective: To assess the role of serum lactate dehydrogenase (LDH) and endometrial thickness in the detection of endometrial carcinoma in perimenopausal bleeding. Methods: This prospective cross-sectional study was carried out at Obstetrics and Gynecology Department, Rajshahi Medical College Hospital, Rajshahi, Bangladesh from January 2020 to June 2022. This study included 102 women with perimenopausal bleeding admitted to Obstetrics & Gynecology Department at RMCH. All cases were subjected to full history, full clinical examination, transvaginal sonography, serum LDH, and Diagnostic endometrial biopsy was taken for histopathological examination. Result: In this study, endometrial thickness at 11.5mm cut-off value showed 80.6% sensitivity, 53.7% specificity, PPV 53.7%, NPV 80.5%and diagnostic accuracy 64.4%. It was found that TVS evaluation of endometrial thickness is not sensitive enough to detect cancer of the endometrium and therefore, could not replace the 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 80.6%, specificity of 57.4%, PPV of 55.7% and NPV of 81.5% with a diagnostic accuracy of 66.7%. Thus, total serum LDH can be used as a good negative test using the cut-off level (430 U/L). A combination of evaluation of endometrial thickness by TVS (with a specificity of 53.7% and accuracy of 64.4%) and serum LDH (with a specificity of 57.4% and accuracy of 66.7%) increase the specificity to 72.2%. also, increase the accuracy to 67.7%. Conclusion: 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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