Histopathological correlation of transvaginal sonography and hysteroscopy in women with postmenopausal bleeding

Background: Postmenopausal bleeding is defined as vaginal bleeding occurring after 12 months of amenorrhea. It is a symptom which may have benign or malignant etiology and hence prompt examination is necessary to make a correct diagnosis. This is a prospective interventional study conducted to correlate findings of transvaginal sonography (TVS), hysteroscopy/ versascopy and the final histopathological diagnosis.Methods: Prospective study was conducted in 100 patients with post-menopausal bleeding. All patients underwent TVS followed by hysteroscopy and guided biopsy, results of which were compared with the gold standard i.e., histopathology.Results: For diagnosing abnormal histopathology, the overall sensitivity and specificity for TVS was 85.96% and 34.88% respectively whereas it was 70% and 72% respectively for hysteroscopy. For diagnosing malignancy, the sensitivity and specificity of TVS was 91.6% and 25% respectively and was 91.6% and 100% respectively for hysteroscopy. On combining both modalities the sensitivity and specificity increased to 83% and 100% respectively.Conclusions: TVS can be used as screening modality with cut off endometrial thickness (ET) of 4 mm with good sensitivity. However, specificity is low, hence hysteroscopy followed by endometrial biopsy is recommended as the diagnostic modality in evaluation of postmenopausal bleeding.