ENDOMETRIAL ASSESSMENT BY VAGINAL ULTRASONOGRAPHY MIGHT REDUCE ENDOMETRIAL SAMPLING IN PATIENTS WITH POSTMENOPAUSAL BLEEDING - A PROSPECTIVE-STUDY

The purpose of this study is to compare transvaginal sonographic endom etrial assessment with histology obtained by endometrial curettage in postmenopausal patients and to determine a cut-off point for endometri al thickness to reduce unnecessary diagnostic curettage for postmenopa usal bleeding. A total number of 289 postmenopausal women were studied prospectively; 192 patients with postmenopausal bleeding and 97 postm enopausal women without bleeding comprised the study and control group s respectively. All patients were scanned by ultrasound transvaginally , then dilatation and curettage was performed for endometrial evaluati on. In all women with and without postmenopausal bleeding, endometrial thickness of 4 mm or less as depicted by sonography correlated well w ith 'atrophic endometrium' (100%). Of 158 women with an endometrium > 4 mm in both groups, 40 women (25.1%) had a negative result (tissue in sufficient for diagnosis or atrophic endometrium), while 118 patients (74.8%) had a positive result which included proliferative and secreto ry endometrium, endometrial hyperplasia, polyps and cancer. As the end ometrial thickness increased, the probability of finding pathology wit h curettage was increased Linearly in postmenopausal bleeding (PMB) po sitive and negative groups and there was a significant linear positive correlation between PMB (+) and (-) cases (Linear regression, R = 0.9 1, p < 0.03). A significant difference was found between endometrium c arcinoma and all other endometrial pathologies concerning the mean end ometrial thickness of 22.7 +/- 10.2 mm (chi-square, p < 0.0001). Also, the mean endometrial thickness of 4.7 +/- 3.3 mm for atrophic endomet rium and 6.1 +/- 3.7 mm for 'tissue insufficient for histological diag nosis' were found significantly different than all other endometrial p athologies (chi-square, p < 0.0001). Endometrial thickness of less tha n or equal to 4 mm may serve as cut-off point for predicting pathology negative cases with an accuracy of 100% in postmenopausal bleeding po sitive and negative cases. Then as the endometrial thickness increases , the probability of finding endometrial pathology in curettage increa ses linearly with;a positive predictive value of 74.6%.