Publication:

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.