EVALUATION OF DIFFERENT TRANSVAGINAL SONOGRAPHIC DIAGNOSTIC PARAMETERS IN WOMEN WITH POSTMENOPAUSAL BLEEDING

Objective To determine whether the accuracy of transvaginal sonography to detect endometrial pathology is enhanced by assessing endometrial morphology and the regularity of the endometrial border in addition to measurement of endometrial thickness in women with postmenopausal ble eding. Design and methods A total of 159 women with post-menopausal bl eeding were included in a prospective study performed at the Clinic of Obstetrics and Gynecology, University of Mainz. The results obtained on transvaginal sonographic assessment of the endometrium were compare d with the histological evaluation of the operative endometrial specim en. Results A cut-off level for endometrial thickness of 5 mm had a se nsitivity of 94%, specificity of 48% and positive and negative predict ive values of 69% and 87%, respectively for the presence of endometria l pathology. Assessment of the regularity of the endometrial border sh owed a sensitivity of 75%, specificity of 66% and positive and negativ e predictive values of 73% and 69%, respectively. For the third sonogr aphic parameter, endometrial morphology, the sensitivity was 82%, spec ificity 64%, the positive predictive value 73% and the negative predic tive value 74%. The combined consideration of the three sonographic pa rameters showed a sensitivity of 97%, specificity of 65%, and positive and negative predictive values of 80% and 94%, respectively. Conclusi on The combined evaluation of endometrial thickness, endometrial morph ology and the endometrial border enhances the accuracy of transvaginal sonography to detect endometrial pathology in women with postmenopaus al bleeding, thus facilitating the decision regarding further diagnost ic and therapeutic measures.