Publication:

Sensitivity and specificity of transvaginal ultrasonography in detecting endometrial pathology in women with postmenopausal bleeding

Background Postmenopausal vaginal bleeding is a frequent reason for gynecological consultation. Transvaginal ultrasonography (TVS) is a key diagnostic tool for assessing endometrial pathology through the measurement of endometrial thickness in such patients. This study aimed to evaluate the sensitivity and specificity of TVS in detecting endometrial pathology in women with postmenopausal bleeding, using histopathological findings as the reference standard.

Methods This cross-sectional study was carried out in department of obstetrics and gynaecology of DMCH, from June 2022 to May 2023. A total of 65 women with post-menopausal vaginal bleeding were included after taking informed written consent.

Results The study included 65 women with postmenopausal bleeding, with a mean age of 55.5±7.6 years. Histopathological analysis revealed abnormal endometrial findings in 70.8% of cases: 47.8% had endometrial hyperplasia, 23.9% endometrial atrophy, 13.1% endometrial carcinoma and 15.2% endometrial polyp. On TVS, the mean endometrial thickness was 9.1±6.1 mm; 58.5% had a thickness>5 mm, while 41.5% had ≤5 mm. ROC curve analysis identified a cut-off value of ≥4.99 mm (AUC=0.880; 95% CI: 0.785–0.975; p<0.01) for detecting endometrial pathology, demonstrating 82.61% sensitivity, 73.68% specificity, 88.37% positive predictive value (PPV), 63.64% negative predictive value (NPV) and 80% overall accuracy. Another ROC analysis for detecting endometrial carcinoma revealed an optimal cut-off value of ≥13.5 mm (AUC=0.935; 95% CI: 0.875–0.995; p<0.01), with 100% sensitivity, 86.44% specificity, 42.86% PPV, 100% NPV and 87.69% accuracy.

Conclusions Transvaginal ultrasonography has high sensitivity and specificity in detecting endometrial pathology in women with postmenopausal bleeding. However, further larger studies in different surgical units are warranted.