TRANSVAGINAL ULTRASONOGRAPHY COMPARED WITH ENDOMETRIAL BIOPSY FOR THEDETECTION OF ENDOMETRIAL DISEASE

Background Transvaginal ultrasonography is a noninvasive procedure tha t may be used to detect endometrial disease. However, its usefulness i n screening for asymptomatic disease in postmenopausal women before or during treatment with estrogen or estrogen-progesterone replacement i s not known. Methods We compared the sensitivity and specificity of tr ansvaginal ultrasonography and endometrial biopsy for the detection of endometrial disease in 448 postmenopausal women who received estrogen alone, cyclic or continuous estrogen-progesterone, or placebo for thr ee years. Results Concurrent ultrasonographic and biopsy results were available for 577 examinations in the 448 women, 99 percent of whom we re undergoing routine annual follow-up. Endometrial thickness was less than 5 mm in 45 percent of the examinations, 5 to 10 mm in 41 percent , more than 10 mm in 12 percent, and not measured in 2 percent, and it was higher in the women receiving estrogen alone than in the other gr oups. Biopsy detected 11 cases of serious disease: 1 case of adenocarc inoma, 2 cases of atypical simple hyperplasia, and 8 cases of complex hyperplasia. Biopsy also detected simple hyperplasia in 20 cases. At a threshold value of 5 mm for endometrial thickness. transvaginal ultra sonography had a positive predictive value of 9 percent for detecting any abnormality, with 90 percent sensitivity, 48 percent specificity, and a negative predictive value of 99 percent. With this threshold, a biopsy would be indicated in more than half the women, only 4 percent of whom had serious disease. Conclusions Transvaginal ultrasonography has a poor positive predictive value but a high negative predictive va lue for detecting serious endometrial disease in asymptomatic postmeno pausal women. (C) 1997, Massachusetts Medical Society.