Clinical Study Of Transvaginal Sonography And Hysteroscopy In The Diagnosis Of Postmenopausal Uterine Bleeding

Objective The aim of the study was to evaluate the clinical value of transvaginal sonography, hysteroscopy as well as in combination of these two methods in the diagnosis of postmenopausal uterine bleeding.Methods From January 2005 to October 2006, 89 patients from the Jinan central hospital were studied prospectively, who have postmenopausal bleeding, however, no pathological changes of vulvae, vagina, and cervix through gynecology inspection and cervical smear, and removed from the bleeding aroused by hormone replacing treatment,take tamoxifen as well as IUD. All patients were carried out TVS inspection, and in TVS inspection the same day or next day the hysteroscopy was carried out. The results were compared with the histopathologic diagnosis of specimens obtained by D&C, hysteroscopy or hysterectomy so as to evalute the diagnostic accordance rate of transvaginal ultrasonography and hysteroscopy in the diagnosis of postmenopausal uterine bleeding.Results 1.TVS method: The 5mm was set as the cutoff point of endometrial thickness for postmenopausal women to detect endometrial abnormalities. The surgical-pathologic examination confirmed normal physiologic endometrium in44(93. 62%) of 47 women who were said to have normal endometrium on transvaginal sonography. 31 (73. 81%) of 42 women diagnosed of intracavitary pathologies on transvaginal sonography were confirmed by surgical-pathologic findings. The sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, and false negative rate of transvaginal sonography in the detection of intracavitary pathology were 91. 18%, 80.00%, 73.81%, 93.62%, 26.19%, and 6. 38%, respectively, whereas 100%, 64. 38%, 38. 10%, 100%, 61. 90%, 0 were obtained respectively when TVS was used to predict endometrial malignancy and premalignancy. 2. Hysteroscopy method: All patients had good result without any complication during and after the testing, and not a case had been failed because of atrophy of cervix. Surgical-pathologic results revealed intracavitary pathologies in 1 (1. 85%) of 54 women who were said to have normal endometrium on hysteroscopy. Among 35 women diagnosed of intracavitary pathologies on hysteroscopy, 33 (94.29%) women were confirmed after histological evaluation of the surgical specimens. The sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, and false negative rate of hysteroscopy in the detection of intracavitary pathology were 97.06%, 96.36%, 94.29%, 98. 15%, 5. 71%, and 1.85% respectively, whereas 93.75%, 86.30%, 62.50%, 96.92%, 37. 50%, 3. 71% were obtained respectively when hysteroscopy was used to predict endometrial malignancy and premalignancy. The precision of diagnosing endometrial polyp using hysteroscopy is 83. 33%(5/6), that of submucous myoma is 80. 00%(4/5), hyperplasia is 50. 00%(4/8), endometrial cancer is 73. 33%(11/15). 3. Comparison between two methods: Sensitivity, specificity, positive predictive value, and negative predictive value were higher with hysteroscopy in the detection of intracavitary pathology. The comparison of sensitivity, negative predictive value, and false negative rate of two diagnosises, do not have significance discrepancy (p>0.05) on statistics; The comparison of specificity, positive predictive value, false positive rate of two diagnosises , there are notable or very significance discrepancy (p<0. 05 or p<0. 01) on statistics. When screening endometrial malignancy and premalignancy in the two groups, the false negative rate of TVS is 0, and hysteroscopy has the false negative rate of 3.71%; But the specificity and p positive predictive value of hysteroscopy are 86. 30% and 62. 5% respectively and is higher than TVS inspection result, discrepancy has notable or very notable meaning (p<0.05 or p<0.01).Conclusion 1. TVS in postmenopausal uterine bleeding women with 5 mm is the endometrium lesion in critical value diagnosis uterus have higher sensitivity and negative predictive value, neither a case of endometrial malignancy nor premalignancy was missed by TVS, therefore TVS is a kind of very good method of screening the endometrium lesion. 2. For TVS inspection in the thickness of endometrium<5mm, it can be considered safe to exclude the possibility of endometrial malignancy; With an endometrial thickness more than 5mm, hysteroscopy with biopsy or dilatation and curettage is the most appropriate diagnostic method in postmenopausal women with uterine bleeding. 3. For checking the patients of endometrial malignancy and premalignancy , we suggest to apply the combination of TVS and hysteroscopy, as well as combine histopathology to make the diagnosis of cause of disease.