Value of transvaginal ultrasonography in endometrial evaluation of non-bleeding postmenopausal women

Objective To investigate the value of transvaginal ultrasonography (TVU) in the evaluation of the endometrium in postmenopausal women without vaginal bleeding. Methods This was a prospective, cohort, observational study which included 259 consecutive, asymptomatic, postmenopausal women who were referred to the outpatient clinics of Shiraz University of Medical Sciences. All the participants underwent TVU by the same gynecologist at the same time as hysteroscopy and endometrial biopsy were performed. Both 3 mm and 5 mm were considered as cut-off values. Endometrial histopathology was considered the gold-standard diagnosis and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TVU were calculated on the basis of pathologic reports. Results The mean age of the patients was 54.2 +/- 7.46 years (range 36-79 years). The mean endometrial thickness was found to be 3.83 +/- 2.95 mm (range 1-25 mm); it was > 5 mm in 41 (15.8%) patients. The sensitivity, specificity, PPV and NPV were 62.2%, 93.9%, 68.3% and 92.2%, respectively. The receiver-operating characteristics curve showed an area under the curve of 0.853 (95% confidence interval 0.788-0.917), indicating a moderate accuracy. Conclusion TVU is a moderately accurate test in asymptomatic postmenopausal women. Due to its high false-positive rate, its positive results cannot be interpreted.