TRANSVAGINAL ULTRASOUND, ENDOMETRIAL CYTOLOGY SAMPLED BY GYNOSCANN AND HISTOLOGY OBTAINED BY UTERINE-EXPLORA-CURETTE COMPARED TO THE HISTOLOGY OF THE UTERINE SPECIMEN - A PROSPECTIVE-STUDY IN PREMENOPAUSAL ANDPOSTMENOPAUSAL WOMEN UNDERGOING ELECTIVE HYSTERECTOMY

Background. The purpose of this study was to evaluate the diagnostic v alue of transvaginal ultrasound measurement of endometrial thickness, cytology obtained by Gynoscann(R), and histology of the endometrium sa mpled by Uterine Explora Curette(R) compared with histology of the ute rine specimen as the gold standard. Methods. Consecutive patients admi tted for hysterectomy had transvaginal ultrasound, sampling by Gynosca nn(R), and Uterine Explora Curette(R) done just before surgery, after informed consent. Results. A total of 181 women entered the study. Six teen had endometrial cancer, seven had atypical hyperplasia and nine h ad complex hyperplasia. A total of 168 patients had a transvaginal ult rasound done. At a cutoff limit of 4mm (endometrial thickness of 4mm o r less indicating normal endometrium), the sensitivity was 90.3%, the specificity 24.8%, the positive predictive value 21.4% and the negativ e predictive value 91.9%. One endometrial cancer,one atypical and one complex hyperplasia were missed. The Gynoscann(R) method showed a sens itivity of 62.5%, a specificity of 94.0%, a positive predictive value of 69.0% and a negative predictive value of 92.1%. Two cancers, three atypical and six complex hyperplasia were missed. The Uterine Explora Curette(R) showed a sensitivity of 90.6%, a specificity of 100.0%, a p ositive predictive value of 100.0% and a negative predictive value of 98.0%. One endometrial cancer and two complex hyperplasia were missed. Conclusion. Transvaginal ultrasound is a reliable method in excluding endometrial pathology. The Uterine Explora Curette(R) was superior to Gynoscann(R) in diagnosing neoplasia of the endometrium. It was found to have the same diagnostic accuracy as conventional dilatation and c urettage.