Evaluation of Transvaginal Ultrasonography in Premalignant and Malignant Changes in Postmenopausal Bleeding

Background: Postmenopausal bleeding (PMB) is a common problem of elderly women. Golden standard diagnostic method is the pathologic report of Dilatation and Curettage (D&C). In recent studies Transvaginal Ultrasonography (TVS) is discussed as a noninvasive useful method for screening malignancy change in the endometrium. We evaluated vaginal sonography in uterine malignancy.
Methods & Materials: This was an analytical “Clinical Trial” study performed in menopause women who referred to specialized Clinics of Gynecology in Babol. Inclusion criteria were PMB and no hormonal treatment. D&C endometrial sampling and TVS were accomplished for all individuals..
 
Result: The most common pathologic diagnosis in 50 cases, were studied was proliferating endometrium means. Endometrial thickness in them was 12.6±10.4mm. No malignancy was reported in less than 5 mm endometrial thickness. Mean of endometrial thickness in 4 cases (8%), which had malignant changes, was 17.6±13.3 mm. malignant changes in these patients were adenocarcinoma and hyperplasia. Sensitivity of TVS was 100% and specificity was 26%. Positive predictive value was 10.6% and negative predictive value was 100%. Efficacy of this method was 32%.
 
Conclusion: TVS isnot a reliable diagnostic test for malignancy or premalignancy screening in PMB, if we get endometrial thickness as the only basis of evaluation. But it is reliable in follow-up of patient with less than 5-mm endometrial thickness. It seems that pathologic assessment is still the golden standard for malignancy diagnosis.