Comparative Study of Transvaginal Sonography and Hysteroscopy for Detection of Pathological Endometrial Lesions in Women with Perimenopausal Bleeding

Background:abnormal uterine bleeding is a frequent condition in gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of haemostatic substances. In some specific cases with more intense and prolonged bleeding surgical treatment may be necessary. Aim of the Work: this study aimed to estimate the diagnostic accuracy of two dimensional transvaginal ultrasound and hysteroscopy compared to the histopathology in evaluation of uterine cavity lesions in peri menopausal women with abnormal uterine bleeding. Patients and Methods: this was a prospective cohort study and it included 50 patients from Obstetrics and Gynecology Outpatient Clinic at Al-Hussein and Bab El-Shearia (Sayed Galal) Hospitals, Al-Azhar University during the period from October 2017 to May 2018. Results: 2D TVS were more sensitive and a little more accurate than hysteroscopy in detecting endometrial hyperplasia, while hysteroscopy showed higher specificity. Hysteroscopy showed highest accuracy for diagnosis of the endometrial polyp and was more sensitive, specific and accurate than 2D TVS in this diagnosis. 2D TVS were more sensitive and accurate than hysteroscopy in the diagnosis of adenomyosis, but both showed same specificity. For differentiating normal from abnormal endometrial cavity both 2D TVS and hysteroscopy showed high accuracy, but U/S was more sensitive and a little more accurate than hysteroscopy, while the last was more specific. Both 2D TVS and hysteroscopy ignore the diagnoses of one lesion when endometrial hyperplasia, endometrial polyp or adenomyosis were found in one case. Conclusion: endometrial hyperplasia was the commonest observed endometrial abnormality in our patient sample and the second most common pathology was the endometrial polyp.