Diagnostic accuracy in transvaginal echography in benign endometrial diseases and its comparison with hysteroscopic biopsy

: Abnormal uterine bleeding is one of the main indications for hysteroscopy in peri-menopausal age. Transvaginal ultrasound allows for an accurate study of the endometrium through the evaluation of thickness, homogeneity. The aim of this retrospective study was the evaluation of transvaginal ultrasound versus hysteroscopy in diagnostic approach to abnormal uterine bleeding in peri- and post-menopause. 130 Women referred to the Department of Obstetrics and Gynecology of the University of Pavia for abnormal uterine bleeding entered the study; all them underwent transvaginal ultrasound and hysteroscopy with directed biopsy, with histological diagnosis of benign endometrial disease. On the basis of endometrial thickness measured at ultrasound, premenopausal patients were divided into two groups, post menopausal patients into three groups, and for each group a comparison between hysteroscopic findings, histological diagnosis and echographic aspect was performed. A 100% correspondence between ultrasound, hysteroscopy and histology was found in the group of subjects with endometrial atrophy, with an endometrial thickness of 2.9 +/- 0.68 at ultrasound; in the remaining groups sensibility and specificity of transvaginal ultrasound seem to be lower. In our experience a cut-off of 4 mm can be established for endometrial thickness measured by transvaginal ultrasound. Values that are below this cut-off point are diagnostic for endometrial atrophy, precluding the need for more invasive examinations: a medical treatment can then be administered. On the contrary, an endometrial thickening of 4 mm or more requires an hysteroscopic examination with directed biopsy and histological diagnosis.