Transvaginal sonography and hysteroscopy versus histopathology in postmenopausal bleeding

ABSTRACT

Transvaginal sonography [TVS] and hysteroscopy were compared with the histopathological results of the Dilatation and curretage [D and C] biopsies in 42 patients attending in Benha University Hospitals with postmenopausal bleeding. Endometrial lesions were detected by histopathology in 23 cases [54.8%], 17 of them were diagnosed by TVS and 14 from the remaining 19 normal atrophic endometrium were diagnosed by it. This gave a sensitivity and specificity of 73.9% and 73.7% respectively and a predictive value as a positive test, as a negative test and efficacy of 77.3%, 70.0% and 73.8% respectively. This efficacy could be increased to 81% by taking in account 5 mm of endometrial thickness as a cut - off level between normal and abnormal endomtetrium with significant difference [P<0.001]. Hysteroscopy diagnosed 18 cases from the 23 endometrial lesions which had been diagnosed by histopathology and 16 from the remaining 19 normal atrophic endometrium. This gave a sensitivity and specificity of 78.3% and 84.2%, respectively and a predicitive value as a positive test, as a negative test and efficacy of 85.7%, 76.2% and 8196 respectively. This study shows that TVS allows detection of an endometrial pathology in the vast majority of cases and as it is easy, relatively cheap, needs no anaethesia and non-invasive it can be used as the first diagnostic step in the investigations of women with postmenopausal bleeding to be supplemented, in the cases needed, by hysteroscopy and histopathological study of D and C biopsy. This will minimize cost, time and complications for the patient