Objective: To assess the value of both transvaginal ultrasonography (TVS) and hysteroscopy in the detection of endometrial abnormalities compared to histopathology in postmenopausal women.
Study design: The study was conducted on 80 postmenopausal women grouped into: Group-A included 50 patients with postmenopausal bleeding (PMB), and Group-B that included 30 cases with another complaint rather than bleeding. They were subjected to full history taking, clinical examination, TVS, hysteroscopy then dilatation & curettege.
Results: Using 5mm endometrial thickness as cut-off value for atrophic endometrium, TVS had 85% sensitivity, 96.7% specificity and accuracy of 92% in cases of PMB. The corresponding values in proliferative endometrium were 75%, 100% and 98%. In cases of endometrial hyperplasia, the sensitivity was 100%, the specificity 88.9% and the accuracy was 94%. However, TVS could not differentiate between different types of endometrial hyperplasia. The sensitivity and specificity of TVS in cases of endometrial carcinoma and submucous leiomyomas were 100%. However, in cases of endometrial polyps it showed sensitivity of 55.6% with a specificity and accuracy of 97.6% and 90% respectively. On the otherhand, compared to hysteroscopy, there was no significant difference between the results of both techniques in diagnosis of various endometrial lesions except in cases of endometrial polyps where hysteroscopy showed a significant higher sensitivity and negative predictive value (P< 0.05). In the non bleeding (Group B) postmenopausal women, there was no significant difference between the results of TVS and hysteroscopy in diagnosis of atrophic and hyperplastic endometrium.
Conclusion: In postmenopausal women, TVS is an excellent noninvasive screening method with high sensitivity & specificity values. In postmenopausal bleeding with endometrial thickness of 5mm or less, transvaginal sonography could reliably diagnose endometrial atrophy and exclude significant endometrial pathology. With more than 5mm endometrial thickness another complementary diagnostic method as hysteroscopy & histopathology are recommended to establish precise diagnosis. |
