Comparison of Transvaginal Ultrasonographic Endometrial Thickness With the Results of Endometrial Biopsy in Perimenopausal Irregular Bleeding

Objective: To compare the efficacy of transvaginal ultrasonography and endometrial biopsy for detection of endometrial pathology in pre-menopausal women with irregular uterine bleeding. Materials and Methods: One hundred and twenty-six women with irregular uterine bleeding participated in the study. Initially, the endometrial thicknesses of participants were evaluated by transvaginal ultrasonography which were followed by endometrial biopsy for histo-pathological assessment. The histo-pathological results were then compared with transvaginal ultrasonography endometrial findings. The assessments of endometrial thicknesses for specific endometrial pathologies were made and the correlations were studied. Different cut off values were studied for efficacy. Results: One hundred and four out of 126 women (82.5%) had normal histological findings, whereas 22 (17.5%) had abnormal histological findings. No endometrial cancer cases were diagnosed in this study. The mean endometrial thicknesses in 104 women with normal endometrial histology and in participants with abnormal histology were 10.9 mm (range 1.5-28 mm) and 15.2 mm (range 4.4-30 mm). The sensitivity, specificity and positive predictive values were 100%, 2%, 18% for a cut-off limit of 4 mm endometrial thicknesses. However better specificity and positive predictive values were obtained with higher cut off values, nearly 20-36% sensitivity defect was observed. Conclusion: Endometrial biopsy is the golden standard test for endometrial pathologies in pre-menopausal women with irregular uterine bleeding. Transvaginal ultrasonography should be used to evaluate the differential diagnosis of endometrial pathologies (such as Myoma uteri) and for current diagnosis it must be used along with endometrial biopsy.