Comparative study of transvaginal sonography and hysteroscopy for the detection of pathological endometrial lesions in women with perimenopausal bleeding

Objective: To estimate the diagnostic accuracy of two dimensional transvaginal ultrasound and hysteroscopy compared with histopathology in evaluation of uterine cavity lesions in perimenopausal women with abnormal uterine bleeding. Design: Descriptive diagnostic trial. Setting: Cairo University Hospital. Materials and methods: A total of 50 patients with perimenopausal bleeding scheduled for 2D TVS, hysteroscopy and histopathologic examination of tissue specimen. Results: The commonest bleeding pattern was menorrhagia (40%) followed by menometrorrhagia in 34%, endometrial hyperplasia was found in about half of these lesions and was associated with endometrial polyp in half of the multiple lesions, endometrial hyperplasia was the most frequent finding by TVS (32%) with a mean endometrial thickness of 11.2±2.4mm followed by endometrial polyp (26%) with a mean endometrial thickness of 18.0±5.3mm. Using hysteroscopy the commonest lesion diagnosed was endometrial polyp which was found in 28% of cases, while endometrial hyperplasia found only in 20%. 2D ultrasound shows good sensitivity in detection of endometrial polyp, highest specificity and accuracy was for adenomyosis. Hysteroscopy was poorly sensitive but highly specific for both endometrial hyperplasia and adenomyosis. For endometrial polyp hysteroscopy was highly sensitive, specific and accurate. Ultrasound was more sensitive and more accurate than hysteroscopy for detection of uterine lesions but hysteroscopy show higher specificity. Conclusion: For differentiating normal from abnormal endometrial cavity both 2D TVS and hysteroscopy show high accuracy but U/S was more sensitive and a little more accurate than hysteroscopy while the last was more specific