Can vaginal ultrasound replace diagnostic curettage in the detection of endometrial pathology in post-menopausal bleeding?

Abstract

Introduction Postmenopausal bleeding refers to vaginal bleeding that occurs after twelve months of amenorrhea in a woman of the age where the menopause can be expected. 1 It can also be defined as the time in a woman's life when the woman stops having a menstrual period permanently and is no longer fertile. 2 However, it can be applied to younger women following premature ovarian failure or premature menopause. 3 Vaginal bleeding is a common post menopausal complaint representing 5% of all gynecology outpatient consultations. 4 The incidence of postmenopausal bleeding is 10% in the general population immediately after menopause. 5 The causes of postmenopausal bleeding include endometrial atrophy (approximately 75% of cases), 3 endometrial polyps, submucosal fibroids, endometrial hyperplasia (simple, complex and atypical), endometrial carcinoma (approximately 10%), and estrogen withdrawal. 6 Non-gynecological causes include trauma, systemic diseases like hypertension, hypothyroidism, and bleeding disorders. 3 Endometrial abnormalities are common diagnostic challenges facing the radiologist and referring specialist gynecologist. Ultrasound is the primary imaging modality in this workup; findings if further investigations done like sonohysterography, hysterosalpingography, magnetic resonance imaging, and computed tomography are often correlated Background and objective: Post-menopausal bleeding due to endometrial abnormalities is a common diagnostic challenge facing the ultrasonogists and referring gynecologists. This study aimed to detect the validity of transvaginal ultrasound to detect endometrial pathologies and its sensitivity and specificity for determining endometrial carcinoma in women with postmenopausal bleeding. Methods: A diagnostic accuracy study of transvaginal ultrasound and diagnostic curettage was conducted for evaluation of endometrial pathology in the College of Medicine, Hawler Medical University from October2016to January 2018. The sample size included 55 women with post-menopausal vaginal bleeding. The ultrasound findings were compared with histopathological results of endometrial biopsy. Results: Out of 55 women, 49.09% had endometrial atrophy, 29.09% had endometrial hyperplasia, 16.36% had endometrial polyp, 3.64% had endometrial carcinoma, and 1.82% had hyperplasia with atypia according to histopathological findings. The sensitivity of ultrasound in detecting cancer was 66.7%, the specificity was 100%, the positive predictive value (PV) was 100%, and the negative predictive value was 98.1%. The total agreement rate was 98.2%. Conclusion: Transvaginal ultrasound is an excellent diagnostic tool to determine whether further investigation with histopathological examination of endometrial biopsy is necessary for postmenopausal vaginal bleeding.