RESUMO
To determine the diagnostic accuracy of transvaginal ultrasound and hysteroscopy in women with postmenopausal bleeding. Between January 1, 2008 and June 30, 2010, 60 women presented to gynaecology outpatient clinics in Aswan, Al-Sahel and Benha teaching hospitals with postmenopausal bleeding were enrolled in this prospective study. They underwent transvaginal ultrasonography followed by hysterpscopy and were submitted to directed biopsy during hysteroscopy. Results were classified as normal/atrophic endometrium, focal lesions [benign or suspicious], and diffuse thickness [benign or suspicious]. Findings were compared with the final diagnosis established by histopathological examination. Results were statistically analyzed to determine the sensitivity, specificity, predictive values and efficacy . The findings established by histopathological examinationwere endometrial atrophy in 22 [36.7%], normal endometrium in 5 [8.33%], polyps in 21 [35%], non-atypical hyperplasia in 4 [6.7%], atypical hyperplasia in 2 [3.33%] and endometrial carcinoma in 6 [10%] cases. Transvaginal ultrasonography revealed sensitivity 81.82%, specificity 88.89%, positive predictive value 90% negative predictive value 72.72%. Hysteroscopy revealed sensitivity, specificity, positive predictive value, negative predictive value and efficacy of 90.9%, 92,59% 93.75%, 89.28%, 91.67% respectively. As transvaginal ultrasonography is relatively safe and accurate, it should be used as first choice diagnostic tool in women with postmenopausal bleeding. Hysteroscopy is superior diagnostic procedure and should be performed whenever endometrial thickness measured by transvaginal ultrasonography >4mm. In these hysteroscopic directed biopsy should be performed to achieve accurate diagnosis