THE ROLE OF TRANSVAGINAL ULTRASOUND IN THE INVESTIGATION OF WOMEN WITH POSTMENOPAUSAL BLEEDING

One-hundred and eighty-two women with post menopausal bleeding mere ex amined with transvaginal ultrasound (TVUS) over a 16-month period. The imaging findings were correlated with the pathological specimens. One -hundred and forty had pipelle aspiration cytology and 35 hysteroscopy , dilatation and currettage and seven a hysterectomy. Endometrial thic kness on TVUS was classified as either thin (equal to or less than 5 m m), thick (greater than 5 mm), or not seen. A thin endometrium was not ed in 87 patients, in whom no pathological abnormality was found in 84 (negative predictive value 95%), There were three cases of hyperplasi a or polyps but no carcinomas occurred in this group (negative predict ive value for carcinoma 100%). A thickened endometrium was noted in 82 patients. In this group there were five carcinomas, nine polyps and e ight cases of endometrial hyperplasia (positive predictive value 29%). In five patients the endometrium could not be identified. One carcino ma occurred in this group. There were an additional eight patients who were taking tamoxifen who were grouped separately. If a clear symmetr ical endometrial stripe measuring less than or equal to 5 mm in thickn ess on TVUS is seen the probability of malignancy is extremely low and endometrial biopsy can probably be avoided in this group particularly in the context of an isolated episode of postmenopausal bleeding. If the endometrium is not seen or is thicker than 5 mm then endometrial b iopsy is indicated.