Value Of Transvaginal Ul Trasonography, Hysteroscopy In Relation With Endometrial Histopathology For The Evaluation Of Postmenopausal Bleeding

Postmenopausal bleeding (PMB) is an important gynecological• symptom, as it may be the first clinical indication of underlying cancer. Uterine causes of PMB include atrophic endometrium, hyperplastic endometrium, disordered proliferative endometrium, endometrial polyps, and endometrial carcinoma.Although curettage has been used as a golden standard for detecting pathological lesions in the endometrium, yet the procedure has certain limitations, being an invasive procedure together with the possibility of missing intrauterine pathological lesions. Also,• considering that the majority of women with PMB actually have no endometrial pathology and more than 70% of diagnostic curettages are benign, it would be therefore valuable to evaluate the role of other simple methods for screening of endometrial abnormalities in cases ofPMB as TVS and hysteroscopy.The aim of tlus work is to evaluate the value of TVS and hysteroscopy in the detection of endometrial abnonnalities in patients with PMB and to correlate their findings with the histopathology of the endometrium obtained by hysteroscopic directed biopsy or by curettage.This study was conducted on •60 patients attending the outpatient brynecological clinic in the Airforce Hospital between August 1998 and November 2000. Patients were divided into two bTTOUps: Group I, including 40 patients with postmenopausal bleeding; and group II, including 20 postmcnopausal \vomen without blccding. Every paticnt \Vas subjected toTVS, diagnostic hysteroscopy, endometrial biopsy and histopathologic evaluation. Results were analyzed statistically.It was concluded that both hysteroscopy and TVS are highly sensitive but hysteroscopy is more specific than TVS in detecting pathological lesions in the endometrium. However, both TVS and hysteroscopy are complementary diagnostic methods and could be accurately used to detect pathologic conditions in patients with PMB; and it is possible to avoid some useless curettages for diagnosis in patients withPMB.