Transvaginal Ultrasonography in Detecting Endometrial Hyperplasia in Post-Menopausal Women
DOI:
https://doi.org/10.37762/jgmds.13-3.913Keywords:
Transvaginal Ultrasonography, Postmenopausal Bleeding, Breast neoplasms; Ultrasonography of breast lesions; Ultrasound strain elastography; Elasticity imaging techniques; Diagnostic accuracy of imaging; Sensitivity and specificity; Predictive value of tests; Histopathological correlation., Histopathology, ROC CurveAbstract
ABSTRACT
OBJECTIVES
This study aimed to determine the diagnostic accuracy of transvaginal ultrasonography in detecting histopathologically confirmed endometrial pathology in post-menopausal women, using histopathological examination as the reference standard.
METHODOLOGY
This descriptive cross-sectional diagnostic accuracy study was conducted at MTI Bacha Khan Medical College and Mardan Medical Complex, Mardan. A total of 93 post-menopausal women were enrolled through consecutive sampling. TVS assessed endometrial thickness and associated ultrasound findings. Histopathological examination of the endometrial sample was used as the reference standard. Data were analyzed using SPSS version 25. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and 95% confidence intervals were calculated. Receiver operating characteristic curve analysis was performed, and the optimal cutoff was determined using the Youden index.
RESULTS
The mean age of participants was 58.8 ± 8.8 years, and the mean endometrial thickness was 8.45 ± 3.67 mm. Histopathology showed normal endometrium in 31 (33.3%) cases, endometrial hyperplasia in 52 (55.9%), and endometrial carcinoma in 10 (10.8%). Using a predefined cutoff of >10 mm, TVS showed sensitivity of 58.1% (95% CI: 45.7-69.5), specificity of 100.0% (95% CI: 89.0–100.0), positive predictive value of 100.0% (95% CI: 90.4–100.0), negative predictive value of 54.4% (95% CI: 41.6–66.6), and diagnostic accuracy of 72.0% (95% CI: 62.2–80.1). ROC analysis showed an area under the curve of 0.935 (95% CI: 0.887–0.984; p < 0.001). The optimal cutoff by the Youden index was ≥5.65 mm, with a sensitivity of 93.5% and a specificity of 77.4%.
CONCLUSION
Transvaginal ultrasonography is a useful initial, non-invasive tool for evaluating endometrial pathology in post-menopausal women. The >10 mm cutoff showed excellent specificity but moderate sensitivity, indicating that it is more useful for ruling in disease than for ruling it out. A lower ROC-derived cutoff may improve screening sensitivity, but histopathological confirmation remains essential for definitive diagnosis.
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