SENSITIVITY & SPECIFICITY OF TRANSVAGINAL ULTRASONOGRAPHY IN DETECTING ENDOMETRIAL PATHOLOGY OF POSTMENOPAUSAL BLEEDING

*Dr. Berkheez Shabir, Dr. Rehana Afshan and Dr. Zahoor Hussain Daraz

ABSTRACT

Title: Sensitivity & specificity of Transvaginal Ultrasonography in detecting endometrial pathology of postmenopausal bleeding”. Introduction: Menopausal women with endometrial pathology usually present with vaginal bleeding having several causes, such as exogenous estrogen usage, atrophic endometritis/vaginitis, endometrial cancer, endometrial/cervical polyps and endometrial hyperplasia. Postmenopausal bleeding represents 5% of all gynecologic outpatient attendances. Lately, Transvaginal Ultrasonography is one of the diagnostic modalities used to evaluate endometrial pathology in women with postmenopausal bleeding. Dilatation and curettage is still considered gold standard for the investigation of endometrial pathology. This study is aimed at determining the sensitivity and specificity of transvaginal sonography in detecting endometrial pathology by confirming it with histologic findings in women with postmenopausal bleeding. Objective: To determine the sensitivity, specificity, positive and negative predictive values of TVS in diagnosis of uterine pathology in postmenopausal bleeding. Method: A cross-sectional study was conducted in the Gynaecological Oncology Division of Department of Obstetrics and Gynaecology BSMMU on 64 menopausal women presenting with vaginal bleeding and visiting our outpatient department. Proper examination was done after taking a detailed history with the help of pre-designed data sheet. TVS was done in patients to measure the endometrial thickness following which fractional curettage was performed and all the biopsy samples were assessed. In this study the sensitivity, specificity, positive and negative predictive values of TVS in the diagnosis of uterine pathology in postmenopausal bleeding was evaluated. Results: Sixty-four menopausal women with postmenopausal bleeding were enrolled in the study. Of them, 09 candidates didn‟t comply with inclusion criteria and were excluded from the study; hence dropout rate was 14%. A total of 55 subjects were followed after TVS with fractional curettage and with histopathology report. Depending on the endometrial thickness the subjects were divided into two groups: ≤ 5mm (Group 1) and >5 mm (Group 2). There were 20 subjects in Group 1 and 35 subjects in Group 2. Out of 55 subjects 44 were in the age group of ≤ 60 years and rest were above 60 years of age. Among 20 subjects in Group1 (≤5mm) 5 subjects had endometrial pathology. Among 35 subjects in Group 2 (>5mm) total 31 subjects had abnormal endometrial pathology. The subjects with endometrial pathology were offered proper medical and surgical intervention accordingly. The sensitivity, specificity, positive and negative predictive values of TVS in the diagnosis of uterine pathology in PMB was evaluated by appropriate statistical analysis. Receiver operator curve (ROC) analysis was performed to determine a cutoff point (5.5mm) with highest sensitivity and specificity; furthermore, Fisher exact test and Independent T test among two groups were estimated and found significant. Conclusion: Transvaginal Ultrasonography has high sensitivity and specificity in determining endometrial pathology and there is a significant relation between endometrial thickness and endometrial pathology. Endometrial thickness of >5.5mm can be used as risk indicator in predicting endometrial pathology and endometrial thickness of >13mm can be used as a risk indicator for endometrial carcinoma.

Keywords: TVS: Transvaginal Ultrasonography ROC: Receiver Operator Curve PMB: Post-Menopausal Bleeding BSMMU: Bangabandhu Sheikh Mujib Medical University.