An evaluation of transvaginal ultrasound in the assessment of endometrial thickness in black South African patients presenting with postmenopausal uterine bleeding

Abstract

The object of this study was to use Transvaginal ultrasound to evaluate the thickness of the endometrium to exclude endometrial abnormality in Black South African women with postmenopausal uterine bleeding. Transvaginal ultrasound is an excellent diagnostic method for assessing endometrial pathology. The study was carried out at the Gynaecological Ultrasound Department, King Edward VIII Hospital. The study included 76 Black women with postmenopausal uterine bleeding. The thickness of the endometrium was measured by Transvaginal ultrasound. The measurement included both endometrial layers (double-layer technique). The Transvaginal ultrasound measurement was compared with the histopathological diagnosis of the biopsy specimens. At the end of the investigation, findings obtained were 3.9% non-representative, 44.8% endometrial adenocarcinomas, 14.5% benign polyp, 3.9% chronic Endometritis, 17.1% benign endometrium, 5.3% endometrial hyperplasia, 9.2% atrophic endometrium, 3.9% myometrial invasion and 1.3% Malignant Mixed Mullerian Tumour. In this study, the thickness of the endometrial echo varied from 5mm to 35mm, with a mean of 18,2mm. When the thickness of the endometrial echo was compared with the histopathological results, the mean value for non-representative was 7.83mm, much lower than the thickness of an active endometrium (13.25mm). In cases with atrophic endometrium, the thickness ranged from 6mm to 30mm with a mean of 15.86mm. The mean value obtained for cases with endometrial adenocarcinoma was 20.32mm (range 11 to 35mm). The sensitivity, specificity and accuracy of Transvaginal ultrasound for detecting endometrial malignancy were 100% if the cutoff limit of 4mm was used In conclusion, this study using Transvaginal ultrasound demonstrated that a thickness limit greater than 8mm was considered in detecting malignancy. No malignant endometrium was thinner than 5mm. Therefore in women with postmenopausal uterine bleeding and an endometrium less than 4mm, it may be justified not to perform further investigations. Transvaginal ultrasound is a simple, well-tolerated safe and reliable method for identifying endometrial thickness in postmenopausal Black South African women.