Objective: To determine whether the accuracy of transvaginal sonography to detect endometrial pathology is enhanced by assessing endometrial morphology and the regularity of the endometrial border in addition to measurement of endometrial thickness in women with postmenopausal bleeding.
Design and methods: A total of 159 women with postmenopausal bleeding were included in a prospective study performed at the Clinic of Obstetrics and Gynecology, University of Mainz. The results obtained on transvaginal sonographic assessment of the endometrium were compared with the histological evaluation of the operative endometrial specimen.
Results: A cut-off level for endometrial thickness of 5 mm had a sensitivity of 94%, specificity of 48% and positive and negative predictive values of 69% and 87%, respectively for the presence of endometrial pathology. Assessment of the regularity of the endometrial border showed a sensitivity of 75%, specificity of 66% and positive and negative predictive values of 73% and 69%, respectively. For the third sonographic parameter, endometrial morphology, the sensitivity was 82%, specificity 64%, the positive predictive value 73% and the negative predictive value 74%. The combined consideration of the three sonographic parameters showed a sensitivity of 97%, specificity of 65%, and positive and negative predictive values of 80% and 94%, respectively.
Conclusion: The combined evaluation of endometrial thickness, endometrial morphology and the endometrial border enhances the accuracy of transvaginal sonography to detect endometrial pathology in women with postmenopausal bleeding, thus facilitating the decision regarding further diagnostic and therapeutic measures.