Hysteroscopy versus transvaginal ultrasonography: finding the better modality for evaluation of postmenopausal bleeding

Abstract

Background: The most common cause of postmenopausal bleeding is benign pathology, but likelihood of malignancy must be promptly excluded. As excision of localized lesion has higher disease-free survival rate and lower morbidity as opposed to treatment for regional-stage disease. Commonly employed blind dilatation and curettage followed by histopathology is the current standard. A screening method with high sensitivity and specificity can help to prevent the invasive procedure and can also improve the accuracy of the biopsy. The objective of the present study was to study and compare the diagnostic accuracy of hysteroscopy and transvaginal ultrasonography in diagnosis of postmenopausal bleeding.Methods: 80 female patients with complaints of postmenopausal bleeding were enrolled and followed up for a period of 10 months. Each patient underwent transvaginal ultrasonography and hysteroscopy followed by endometrial biopsy. Result were analyzed to find sensitivity, specificity, accuracy, PPV and NPV taking histopathological diagnosis as gold standard.Results: Authors found that in 40 patients (50%), the cause of post-menopausal bleeding was caused atrophic endometrium followed by endometrial hyperplasia seen in 14 patients (17.5%). Hysteroscopy had higher overall sensitivity, specificity, NPV and accuracy as compared to transvaginal ultrasonography. Hysteroscopy was found to be highly accurate in diagnosing endometrial carcinoma (100%) and endometrial polyps (100%). However, both methods showed similar accuracy (97.5%) in diagnosis of proliferative endometrium and hyperplasia.Conclusions: Hysteroscopy is comparable to histopathology and superior to transvaginal sonography in the diagnosis of intrauterine causes for postmenopausal bleeding, it also offers the possibility of visualizing macroscopic or focal intra-uterine abnormalities.

Evaluation of Hysteroscopic Findings and Histopathologic Report of Endometrium in Postmenopausal Bleeding

“…Loiacono et al 3 showed 9.8% of cases of postmenopausal bleeding had endometrial carcinoma, this study was almost similar with present study. Bhoj M et al 19 found endometrial carcinoma 10 of patients this study is also similar with present study.…”

“…Loiacono et al 3 for endometrial polyp, hysteroscopy showed sensitivity, specificity, PPV, NPV were 100% respectively, that similar with present study. Bhoj M et al 19 also found same parameters 100% for endometrial polyp.…”

“…Loiacono et al 3 showed same parameters for endometrial carcinoma were 63%, 97%, 77%, and 95% respectively that is lower than present study. Bhoj M et al 19 showed same parameters 100% respectively.…”

“…In accordance, Trojano et al 7 showed a study that was similar with present study. Bhoj M et al 19 showed sensitivity, specificity, PPV, NPV and accuracy 100% respectively.…”

“…Loicano et al 3 showed sensitivity, specificity, PPV, NPV for endometrial hyperplasia were 81%, 96%, 87%, and 93% respectively not compatible with present study. Bhoj M et al 19 showed sensitivity 85.7%, specificity 100%, PPV 100%, NPV 100% and accuracy 97.5% for endometrial hyperplasia.…”