Transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding -a prospective study

Objective. To determine the diagnostic value of transvaginal ultrasonograph y and hysteroscopy in patients with postmenopausal bleeding. Material and methods. Between January 1, 1998 and June 30, 1999, 88 outpati ent women with postmenopausal bleeding were enrolled in a prospective study . They underwent transvaginal ultrasonography and hysteroscopy, and were su bmitted to directed biopsy during hysteroscopy. Findings were classified as normal endometrium, suggestive of atrophy, focal abnormality (benign or su spicious), and diffuse thickness (benign or suspicious). Data was compared with the final diagnosis, established by histological examination, as atrop hy, benign pathology, atypical hyperplasia and endometrial carcinoma. Results. Among 88 women enrolled, 15 were excluded because hysteroscopy was impossible, and four had abandoned the study. The histological findings we re scanty material in 12 (17.4%), atrophy in 24 (34.8%), cystic atrophy in one (1.4%), normal endometrium in five (7.2%), tuberculous endometritis in one (1.4%), polyps in 12 (17.4%), leiomyoma in one (1.4%), non-atypical hyp erplasia in three (4.3%), atypical hyperplasia in one (1.4%) and endometria l carcinoma in nine cases (13.0%). For the assessment of endometrial carcin oma, ultrasonography revealed sensitivity 77.8%, specificity 93.3%, positiv e predictive value 63.6%, negative predictive value 96.6%; and hysteroscopy revealed sensitivity of 88.9%, specificity 98.3%, positive predictive valu e 88.9%, negative predictive value 98.3%. The combined use of both methods revealed sensitivity 100%, specificity 91.7%, positive predictive value 64. 3%, negative predictive value 100%. Conclusions. Both imagiological methods were found to be useful screening t ests for endometrial carcinoma. Hysteroscopy was a superior diagnostic proc edure.