Diagnostic role of transvaginal ultrasound in postmenopausal bleeding and its histopathological correlation

Background: Postmenopausal bleeding (PMB) is a significant clinical symptom, accounting for nearly 5-10% of gynecological consultations in postmenopausal women (1, 2). It may indicate underlying benign or malignant pathology of the endometrium. Timely diagnosis plays a crucial role in reducing morbidity. Transvaginal sonography (TVS) is a simple, accurate, and non-invasive imaging technique for assessing endometrial pathology. Objectives: To evaluate the diagnostic accuracy of transvaginal ultrasound in assessing endometrial thickness among postmenopausal women presenting with vaginal bleeding and to correlate sonographic findings with histopathological examination (HPE) results. Methodology: This prospective cross-sectional study was conducted over one year in the Department of Radiodiagnosis at a tertiary care hospital. Seventy postmenopausal women with vaginal bleeding meeting the inclusion criteria underwent TVS assessment, followed by histopathological evaluation. Correlation between sonographic and histopathological findings was analyzed to determine sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Results: The majority of participants (42.9%) were aged between 51-60 years. The most common associated complaint was vaginal discharge (31.4%). On TVS, 36% had endometrial thickness ?5 mm, 34% between 6-15 mm, and 30% >15 mm. Endometrial thickening (38.6%) was the most common sonographic finding. The sensitivity, specificity, PPV, NPV, and overall accuracy of TVS were 98.1%, 76.9%, 84.3%, 96.7%, and 89.4%, respectively. A statistically significant correlation (p < 0.05) was found between endometrial thickness and histopathological diagnosis. Conclusion: Transvaginal ultrasonography is a reliable, safe, and cost-effective screening tool for evaluating postmenopausal bleeding. It shows a strong correlation with histopathological findings and can serve as a first-line investigation to identify women requiring biopsy or further evaluation.