EC Gynaecology

Introduction: Postmenopausal bleeding (PMB) is a frequent clinical concern and a major warning sign for endometrial carcinoma. Accurate evaluation combining imaging and endoscopic methods is essential for early diagnosis and optimal management.

Objective: To assess the correlation and diagnostic performance of transvaginal ultrasound (TVUS), hysteroscopy, and histopathology in evaluating PMB.

Methods: A retrospective study was conducted over five years (2021-2025) including 240 women presenting with PMB. All patients underwent TVUS, followed by hysteroscopy and targeted endometrial biopsy. Diagnostic concordance, sensitivity, and specificity of each method were analyzed using histopathology as the gold standard.

Results: The mean age was 61.0 ± 8.2 years. Hypertension (56.7%), diabetes (35%), and obesity (33.3%) were the most frequent comorbidities. Histopathological analysis identified endometrial polyps in 43.3%, atrophic endometrium in 25%, hyperplasia in 13.3%, and malignant or pre-malignant lesions in 18.3% of cases.
TVUS showed high diagnostic accuracy for endometrial carcinoma (sensitivity = 81.8%, specificity = 93.9%) but low sensitivity for polyps (23.1%). Hysteroscopy demonstrated superior diagnostic performance with sensitivity and specificity of 100% and 98% for cancer, and 96.2% and 100% for polyps, respectively.

Conclusion: The integration of TVUS, hysteroscopy, and histopathology provides a comprehensive and reliable diagnostic approach to PMB. TVUS serves as an effective non-invasive screening tool, while hysteroscopy remains the gold standard for detecting focal lesions. Histopathology confirms the final diagnosis, ensuring early and accurate detection of endometrial pathology.

 Keywords: Postmenopausal Bleeding; Abnormal Uterine Bleeding; Transvaginal Ultrasound; Hysteroscopy; Endometrial Cancer; Histopathology

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