An assessment of the value of ultrasonographic screening for endometrial disease in postmenopausal women without symptoms

OBJECTIVE: Our purpose was to evaluate the use of transvaginal ultrasonogra phy for the detection of endometrial disease in a population of postmenopau sal women who were without symptoms. STUDY DESIGN: Postmenopausal women were screened for potential inclusion in 2 multicenter, double-blind, placebo-controlled studies of 2 years' durati on to evaluate the safety and efficacy of idoxifene in the prevention of os teoporosis. Baseline endometrial evaluation was performed by transvaginal u ltrasonography and aspiration biopsy of the endometrium. RESULTS: A total of 1926 women were screened by transvaginal ultrasonograph y, and 1833 of them had endometrial thickness less than or equal to6 mm. Fi ve cases or endometrial abnormality (adenocarcinoma [n = 1] and atypical hy perplasia [n = 4]) were detected in the 1750 women from this cohort who und erwent biopsy. The negative predictive value was >99%. One case of adenocar cinoma was detected in the 42 women who had endometrial thickness >6 mm and underwent biopsy. However, the sampling rate (45%) of women with endometri al thickness >6 mm was too low for confidence in the positive predictive Va lue of 2%. CONCLUSIONS: Despite a high negative predictive value, transvaginal ultraso nography may not be an effective screening procedure for detection of endom etrial abnormality in untreated postmenopausal women who are without sympto ms.