Application of Vaginal Ultrasound and Hysteroscopy in the Diagnosis of Perimenopausal Endometrial Lesions

Abstract

Background: This study aimed to investigate the utility of transvaginal ultrasound and hysteroscopy in diagnosing abnormal uterine bleeding in peri-menopausal women. Methods: Between September 2021 and March 2023, 176 women presenting with abnormal uterine bleeding at the Second Affiliated Hospital of Xinjiang Medical University were subjected to both hysteroscopy and transvaginal ultrasound examinations. Results: There was a significant discrepancy between the pathological diagnoses and the findings from transvaginal ultrasound (p < 0.05), with a Kappa coefficient of 0.475, indicating moderate agreement. Similarly, a significant difference was observed between the results of pathological diagnosis and those obtained via hysteroscopy (p < 0.05), with a Kappa coefficient of 0.669, suggesting substantial agreement. The combined diagnostic approach yielded a Kappa value of 0.784, demonstrating a better consistency and indicating superior diagnostic efficacy. In diagnosing peri-menopausal abnormal uterine bleeding, transvaginal ultrasound exhibited a sensitivity of 89.7%, specificity of 66.7%, and a negative predictive value of 46.7%. Hysteroscopy showed higher sensitivity and specificity at 94.8% and 76.2% respectively, but a relatively low negative predictive value of 66.7%. The combined diagnostic approach further improved the sensitivity and specificity to 97.4% and 81.0% respectively, with a negative predictive value of 81.0%, surpassing those of the individual methods. For the etiological diagnosis of abnormal uterine bleeding (AUB) caused by endometrial polyps, hysteroscopy achieved a concordance rate of 93.3%, significantly outperforming transvaginal ultrasound, which had a rate of 77.3% (χ2 = 7.670), thus demonstrating higher detection efficiency. Conclusions: Transvaginal ultrasound and hysteroscopy are valuable diagnostic tools in the etiological assessment of peri-menopausal AUB. Transvaginal ultrasound, being safe and cost-effective, is preferable for initial etiological screening of AUB, though it carries the risk of underdiagnosis and misdiagnosis. Despite the higher cost and reduced convenience of hysteroscopy, its combination with pathological examination significantly enhances the detection rates of cancerous and precancerous lesions. Consequently, the integration of transvaginal ultrasound with hysteroscopy is recommended for the comprehensive diagnostic evaluation of endometrial lesions in peri-menopausal women with AUB, facilitating early diagnosis and treatment.