Sensitivity and specificity of transvaginal ultrasonography in detecting endometrial pathology in women with postmenopausal bleeding

Sanjana Rahman; Taslim Ara Nila; Alif Laila; Fatema Akter; Umme Salma Shilpi; Nargis Sultana; Tanzin Hossain

doi:10.18203/2320-1770.ijrcog20251959

Authors

Sanjana Rahman Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
Taslim Ara Nila Department of Obstetrics and Gynaecology, Shahid Syed Nazrul Islam Medical College Hospital, Kishoreganj, Bangladesh
Alif Laila Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
Fatema Akter Department of Obstetrics and Gynaecology, Shahid Syed Nazrul Islam Medical College Hospital, Kishoreganj, Bangladesh
Umme Salma Shilpi Department of Obstetrics and Gynaecology, Kurmitola 500 Bedded General Hospital, Dhaka, Bangladesh
Nargis Sultana Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
Tanzin Hossain Department of Obstetrics and Gynaecology, Kurmitola 500 Bedded General Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20251959

Keywords:

Endometrial thickness, Endometrial pathology, Transvaginal ultrasonography, Endometrial carcinoma, Postmenopausal bleeding

Abstract

Background: Postmenopausal vaginal bleeding is a frequent reason for gynecological consultation. Transvaginal ultrasonography (TVS) is a key diagnostic tool for assessing endometrial pathology through the measurement of endometrial thickness in such patients. This study aimed to evaluate the sensitivity and specificity of TVS in detecting endometrial pathology in women with postmenopausal bleeding, using histopathological findings as the reference standard.

Methods: This cross-sectional study was carried out in department of obstetrics and gynaecology of DMCH, from June 2022 to May 2023. A total of 65 women with post-menopausal vaginal bleeding were included after taking informed written consent.

Results: The study included 65 women with postmenopausal bleeding, with a mean age of 55.5±7.6 years. Histopathological analysis revealed abnormal endometrial findings in 70.8% of cases: 47.8% had endometrial hyperplasia, 23.9% endometrial atrophy, 13.1% endometrial carcinoma and 15.2% endometrial polyp. On TVS, the mean endometrial thickness was 9.1±6.1 mm; 58.5% had a thickness>5 mm, while 41.5% had ≤5 mm. ROC curve analysis identified a cut-off value of ≥4.99 mm (AUC=0.880; 95% CI: 0.785–0.975; p<0.01) for detecting endometrial pathology, demonstrating 82.61% sensitivity, 73.68% specificity, 88.37% positive predictive value (PPV), 63.64% negative predictive value (NPV) and 80% overall accuracy. Another ROC analysis for detecting endometrial carcinoma revealed an optimal cut-off value of ≥13.5 mm (AUC=0.935; 95% CI: 0.875–0.995; p<0.01), with 100% sensitivity, 86.44% specificity, 42.86% PPV, 100% NPV and 87.69% accuracy.

Conclusions: Transvaginal ultrasonography has high sensitivity and specificity in detecting endometrial pathology in women with postmenopausal bleeding. However, further larger studies in different surgical units are warranted.

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