DIAGNOSTIC ACCURACY OF TRANSVAGINAL ULTRASOUND IN DETECTION OF ENDOMETRIAL CARCINOMA IN POST-MENOPAUSAL BLEEDING KEEPING HISTOPATHOLOGY AS GOLD STANDARD

Abstract

Background: Postmenopausal bleeding (PMB) is a significant clinical symptom often associated with endometrial carcinoma, the most common gynecological malignancy in postmenopausal women. Early and accurate detection is critical for timely management and improved outcomes. Transvaginal ultrasonography (TVS) serves as a non-invasive and cost-effective diagnostic tool for evaluating endometrial pathology, while histopathology remains the gold standard for definitive diagnosis. This study assesses the diagnostic accuracy of TVS in detecting endometrial carcinoma among postmenopausal women with abnormal uterine bleeding, comparing its findings with histopathological results.

Objective: To determine the diagnostic accuracy of TVS in detecting endometrial carcinoma in postmenopausal women presenting with PMB, using histopathology as the reference standard.

Methods: This cross-sectional study included 135 postmenopausal women aged 45–70 years presenting with PMB at a tertiary care hospital. Women on hormone replacement therapy or with known gynecological malignancies were excluded. After obtaining ethical approval and informed consent, demographic and clinical data were recorded. TVS was performed by a single radiologist to assess endometrial thickness, vascularity, and structural abnormalities. Women with suspicious findings underwent dilatation and curettage (D&C) for histopathological examination. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated using standard statistical methods.

Results: The mean age of participants was 58.2 ± 6.4 years, with a mean menopausal duration of 8.5 ± 4.3 years. TVS identified 72 cases (53.3%) as suspicious for malignancy, with histopathology confirming endometrial carcinoma in 68 cases (50.4%). TVS demonstrated a sensitivity of 94.1%, specificity of 88.9%, PPV of 91.7%, NPV of 92.3%, and an overall diagnostic accuracy of 92.0% (p < 0.001).

Conclusion: TVS is a highly sensitive and accurate non-invasive diagnostic modality for detecting endometrial carcinoma in postmenopausal women with abnormal uterine bleeding. However, histopathological confirmation remains essential to minimize false-positive diagnoses. Integrating TVS as an initial screening tool can facilitate early detection and improve patient outcomes.