The comparison of transvaginal ultrasonography and histopathology results in the evaluation of the endometrium in patients with postmenopausal bleeding

Abstract

ABSTRACT

Introduction

Postmenopausal bleeding (PMB) accounts for 5% of gynecological hospital admissions. The most important step in endometrial pathologies is to exclude malignancy. We aim to evaluate transvaginal ultrasonography (TVUSG) findings and endometrial biopsy results in patients with PMB, to compare them in terms of correlation.

Materials and method

Patients who admitted to hospital with PMB between January 2016 and January 2021 were retrospectively included. Demographic datas, age at menarche, duration of menopause and duration of PMB were recorded. Histopathology results of endometrial biopsy and TVUSG findings were compared. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of endometrial thickness (ET) measured by TVUSG in terms of histopathological positivity and adenocarcinoma were investigated.

Results

Overall 200 women included; the median age was 53.5 years (min 40-max 60) and 12.5% ​​were nulliparous. In TVUSG, ET was ≤5 mm in 34.0% (n=68) of the patients, 6-10 mm in 32.5% (n=65), 11-15 mm in 21.5% (n=43) and 12.0%. in (n=24) was >15 mm. The parity number was found to be statistically significantly lower in patients with ET 0-5 mm (respectively, 2 vs. 4) (p=0.027). Endometrial polyps were detected on TVUSG in 27.5%. The adenocarcinoma and endometrial atrophy rates were 5.5% and %6.0, respectively. The frequency of adenocarcinoma was statistically significantly higher in patients with ET >15 mm on TVUSG (p=0.031). The mean ET of the patients with adenocarcinoma was 13.8 (SD±8.9) mm. The sensitivity, specificity, PPV and NPV of ET >5 mm in TVUSG for histopathological endometrial pathology and adenocarcinoma were 76.1%-92.9%, 31.2%-34.9%, 68.8%-90.9% and 40.8%-93.3, respectively.

Conclusion

TVUSG is a non-invasive, easy-to-use method with rapid results for PMB. Although it is guiding and has high sensitivity, it is not a definitive diagnosis method. If in doubt, endometrial biopsy should be performed.