Transvaginal sonography and hysteroscopy in postmenopausal uterine bleeding

Objective: To compare the diagnostic accuracy of transvaginal ultrasound an d hysteroscopy in the detection of endometrial pathologies in women with po stmenopausal bleeding not using hormonal replacement therapy (HRT). Methods : Between January 1997 and April 1998, 106 postmenopausal women with uterin e bleeding not using HRT underwent a diagnostic work-up including pelvic ex amination, transvaginal ultrasound, hysteroscopy and endometrial biopsy. So nographic measurement of endometrial thickness and hysteroscopic findings w ere compared with histological results. The 'classification tree' method wa s used to identify cut-off values of sonographic endometrial thickness that could be indicative of a class of uterine pathology. Statistical analysis was performed with the McNemar test. Results: No case of endometrial cancer was found with a cut-off point of 5 mm of endometrial thickness evaluated by ultrasound, whereas all patients with endometrial thickness greater than or equal to 15 mm at sonography had an endometrial carcinoma. In the group of patients with endometrial thickness between 6 and 14 mm, we found norma l atrophic endometria, benign and malignant pathology. On the other hand, t he McNemar test showed a very good correspondence between hysteroscopy and histology (sensitivity 97.5% and specificity 100%), confirming its usefulne ss in diagnosis of postmenopausal uterine bleeding. Conclusions: Transvagin al ultrasound has revealed some limitations, mainly in the group of patient s with endometrial thickness between 6 and 14 mm. The absence of endometria l malignancy in women with endometrial thickness less than or equal to 5 mm and the high possibility of cancer in those with endometrial thickness gre ater than or equal to 15 mm should be confirmed in larger series. Hysterosc opy proved to be a simple and safe outpatient procedure with a high diagnos tic accuracy, and in our opinion it should be considered in all women with postmenopausal uterine bleeding. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.