The value of transvaginal ultrasonography in postmenopausal uterine bleeding

Abstract

Objective: Endometrial carcinoma is the most common gynecologic malignancy and usually present with postmenopausal bleeding. For invastigating postmenopausal bleeding there is a trend to less invasiv procedures without compromising efficacy and safety. Transvaginal ultrasonography was suggested as a first-step procedure in evaluating women with postmenopausal bleeding. The aim of this study to evaluate the diagnostic accuracy of transvaginal ultrasonography and endometrial histopathology findings in patients presenting with postmenopausal bleeding. Material and Methods: This cross-sectional retrospective study was conducted in Bolu İzzet Baysal State Hospital Obstetric and Gynecology outpatient clinic with the complaint of postmenopausal bleeding of 1856 patients' records.within the date of January 2011 - January 2013. Bleeding occurring at least 12 months after amenorhe is defined as postmenaupausal bleeding. A total of 312 patients, who had hystopathologic results, whose endometrial thicknes was measured by TvUSG and who did not use hornonal drug were enrolled in the study. Results: Histological diagnosis of 312 women included in this study; were in atrophy (39.1%) and hyperplasia (simple 18.2% + atypical 6%, respectively) were the most common encountered normal and abnormal endometrial findings. The prevalence of endometrial cancer and atypical hyperplasia was 6.4% (n=20) and 6% (n=19) respectively. Endometrial thickness was significantly higher in the pathologic lesion group than in control (p<0.001). When the cut-off value for endometrial thickness was accepted <5 mm, sensitivity, specifity, positive predictive value and negative predictive value was found 96.45%, 76.02%, 76.8% and 96.3% respectively. Conclusion: Endometrial thickness measurement with transvaginal ultrasonography when a cut off value of >5 mm is used is a valuable and safe method in evaluation of patients with postmenopausal bleeding. Endometrial curettage is needed in the cases having endometrial thickness above the 5 mm. Copyright © 2013 by Tükiye Klinikleri.