Transvaginal Sonogram and Hysteroscopy Findings in the Assessment of Endometrial Lesions

November 2006 Introduction Endovaginal (EV) ultrasound scanning is being used in the investigation of post-menopausal bleeding (PMB). The bleeding could be the result of a number of factors; endometrial polyps are one of the common findings in these patients. The aim of the study was to correlate the findings of the endo-transvaginal scan (TVS) to hysteroscopy findings, in order determine the sensitivity and predictive values of both. Material & Methods This was a retrospective study that looked at 37 patients with PMB referred for endovaginal ultrasound, hysteroscopy and biopsy investigations. Result Thirty-seven patients with PMB were scanned using TVS and hysteroscopy. The result was not specific or sensitive using TVS alone. 76% presented generalized endometrium thickening and 24% failed to present any identifiable thickening. 22 polyps were missed using TVS and it were found by hysteroscopy. Conclusion TVS alone is not sensitive enough to diagnose polyps in PMB patients. If it is compounded with hysteroscopy, the reliability is much higher. Introduction Postmenopausal bleeding is a relatively common presentation that can be a source of anxiety because it is a symptom common to both benign and malignant conditions. Menopause (MP) is the permanent cessation of menstruation resulting from the loss of follicular ovarian activity1. Generally, PMB is regarded as bleeding from the genital tract one or many years following the cessation of menses2. In most cases of postmenopausal bleeding (PMB) no organic cause is found. Some form of further investigation is required in order to exclude the possibility of malignancy3 or to identify the existence of benign conditions such as, endometrial hyperplasia or polyps. Diagnosis is often made from histological samples obtained during a hysteroscopy and D&C. The latter are invasive and may be avoided if there is an initial assessment with sufficient reliability to identify those who need further treatment. Transvaginal ultrasound is a non-invasive technique that can be assessed for this purpose. PMB is regarded as an indicator to perform invasive procedures such as hysteroscopy, endometrial biopsy 4 or dilation and curettage (D&C)5, 6. D&C, although generally considered to be the gold standard when assessing the endometrium, is invasive and of limited sensitivity7. Malignant endometrial conditions are diagnosed only in a minority of women with PMB. If the risk remains high enough that patients require further investigation, there remains a need for a less invasive test which is well-tolerated by patients and relatively inexpensive 4, 8, 9. Studies have favored the use of transvaginal ultrasound as an initial investigation for women with PMB. This may raise the need for a more invasive D&C, hysteroscopy or biopsy 4, 10. The identification or exclusion of an endometrial malignancy is the primary goal of scanning this group of PMB patients4, 9. It is important that the presences of a benign pathology, such as endometrial polyps, can be detected and confirmed as the cause of abnormal bleeding. Endometrial polyps are relatively common in both pre and post menopausal women, and found in up to 10% of females7. They maybe permanently attached, pedunculated, single or multiple and can be associated with endometrial hyperplasia7. They are usually less then one cm in size.