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Abstract

Objective: To compare transvaginal ultrasound measured endometrial thickness and histopathological findings for detection of endometrial cancer in postmenopausal bleeding.
Study Design Comparative cross sectional study
Settings Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, Lahore.
Duration of Study 18 months 19.02.2008 to 17.08.2009.
Subjects and Methods Fifty patients having more than one-year duration of menopause, and not on homone replacement therapy, complaining of vaginal bleeding or discharge presented through OPD , were included in the study. After informed consent and ensuring their confidentiality, the detailed history was taken including age, parity, and duration of menopause, postmenopausal bleeding, postcoital bleeding and vaginal discharge. After speculum and pelvic examination, endometrial thickness was measured with transvaginal ultrasound. Endometrial sampling was done by dilatation and curettage. Endometrial curetting were sent for histopathology. The result of histopathological findings was compared with the result of transvaginal ultrasonographic findings.
Results Mean age of the patients was found to be 57.92 + 6.25 years. Mean parity of the patients was P5 with range of 2 to 10.Mean duration of menopause was 7.76+5.75 years. Mean duration of postmenopausal bleeding was 4+2.9 months. 26 % of patients had complaint of vaginal discharge and 36 % of patient had postcoital bleeding. Out of 8 cases of cancer patients, one case (12.5%) of endometrial cancer occurred in patients with endometrial thickness of less than 5mm but 7 cases (87.5%) of cancers occurred in patients whose endometrial thickness was between 5 to 16mm. On histopathology of endometrium, 84% had benign endometrium and 16% had endometrial cancer. The results of transvaginal ultrasound measured endometrial thickness shows the, sensitivity rate 87.5%, specificity rate 38.09%, diagnostic accuracy 46%, positive predictive value 21.21% and negative predictive value 94.12%.
Conclusion This study suggests that in postmenopausal bleeding, endometrial thickness measured by transvaginal ultrasound of <5mm does not appears to exclude endometrial cancer as a cause of postmenopausal bleeding so endometrial sampling must be done in all postmenopausal patients.