www.smso.

net
Transvaginal Sonography and Endometrium
Galal Lotfi. MD, MRCOG
Professor Obstetrics & Gynecology
Suez Canal University
Egypt
www.smso.net
Aim Of Work
To stydy the efficacy of TVS in
dignosing abnormal
Endometrial pattern in
postmenopausal women
www.smso.net
Introduction
Screening Methods Include:
Pap Smear; specificity and
sensitivity
Endometrial cytology
Office Biopsy; Clinical and
technical difficulties
D&C add anestetic hazards and
limitations
www.smso.net
Drawbacks
Smear: lack of specificity and sensitivity
Endometrial cytology: Clinical and
technical difficulties
Office Biopsy; Clinical and technical
difficulties
D&C: Invasive, Costly, Anesthesial
www.smso.net
Design
Antrospective study for
Postmenopausal women,
without or with
postmenopausal bleeding
www.smso.net
Material and Methods
Postmenopausal women
with no bleeding , n=187
Postmenopausal women
with bleeding, n=132.
www.smso.net
Material and Methods, cont..
All women were subjected to
TVS for pelvic assessment and
endometrial thickness measurement
Pap smea
D&C biopsy

www.smso.net
Mareial and Methods cont
Postmenopausal women without bleeding
n=187
group Ia: high risk group n=36
group Iib: low risk group n=131

Postmenopausal woen without bleeding n=187
group Ia: high risk group n=72
group Iib: low risk group n=60

www.smso.net
Risk Factors:
Diabetes
Hypertension
Obesity
Previous abnormal smea
PCO
Family History
www.smso.net
RESULTS
Table (1): TVS results of group I; postmenopausal women without bleeding. (n=187)
Endometrial thickness High Risk Group LowRisk Group X2 P
Endometrial thickness
=<4mm
31 117 25.3 <0.005
Endometrial thickness
>4<8mm
7 8 1.4 NS
Endometrial thickness
>8<12mm
12 5 12.7 <0.005
Endometrial thickness >12 6 1 8.3 <0.005
Total 56 131
www.smso.net
Results

Table (1): TVS results of group I; postmenopausal women without bleeding. (n=187)
Endometrial thickness High Risk Group Low Risk Group X2 P
Endometrial thickness
=<4mm
31 117 25.3 <0.005
Endometrial thickness
>4<8mm
7 8 1.4 NS
Endometrial thickness
>8<12mm
12 5 12.7 <0.005
Endometrial thickness >12 6 1 8.3 <0.005
Total 56 131
www.smso.net
Results cont.
Table (2): TVS results of group II; postmenopausal women with bleeding. (n=132)
Endometrial thickness High Risk Group Low Risk Group X2 P
Endometrial thickness
=<4mm
28 37 6.8 <0.005
Endometrial thickness
>4<8mm
11 10 0.05 0.8
Endometrial thickness
>8<12mm
20 9 11.1 <0.005
Endometrial thickness >12 13 4 3.7 0.05
Total 72 60
www.smso.net
Results cont...
Table (3): TVS results of endometrial thickness, cytology and endometrial sampling in low
risk women in groupI; postmenopausal women without bleeding. (n=131)
Endometrial thickness Abnormal sample Abnormal smear
Endometrial thickness =<4mm 0/117 0/117
Endometrial thickness >4<8mm 0/8 1/8
Endometrial thickness >8<12mm 2/5 2/5
Endometrial thickness >12 1/1 1/1
Total 3/131 3/131
www.smso.net
Results cont..
Table (5): TVS results of endometrial thickness, cytology and endometrial sampling in low
risk women in groupII; postmenopausal women with bleeding. (n=60)
Endometrial thickness Abnormal sample Abnormal smear
Endometrial thickness =<4mm 0/37 6/37
Endometrial thickness >4<8mm 3/10 4/10
Endometrial thickness >8<12mm 4/9 4/9
Endometrial thickness >12 3/4 4/4
Total 10/60 18/60
www.smso.net
Results cont..
Table (6): TVS results of endometrial thickness, cytology and endometrial sampling in low
risk women in groupII; postmenopausal women with bleeding. (n=72)
Endometrial thickness Abnormal sample Abnormal smear
Endometrial thickness =<4mm 6/28 5/28
Endometrial thickness >4<8mm 7/11 4/11
Endometrial thickness >8<12mm 13/20 17/20
Endometrial thickness >12 9/13 7/13
Total 35/72 33/72
www.smso.net
Results Cont..
Table (4): TVS results of endometrial thickness, cytology and endometrial sampling in high
risk women in groupI; postmenopausal women without bleeding. (n=56)
Endometrial thickness Abnormal sample Abnormal smear
Endometrial thickness =<4mm 0/31 0/31
Endometrial thickness >4<8mm 0/7 1/7
Endometrial thickness >8<12mm 2/12 5/12
Endometrial thickness >12 6/6 6/6
Total 8/56 12/56
www.smso.net
RESULTS
www.smso.net
TVS:
Delineate the endometrium
Measures the endometrila thickness
Detects associated endometrial
pathology
Detects other pathology in the pelvis
www.smso.net
Other pathology detected
Endometrila polyps
Samall fibroid
Adenomyosis
Hydrosaplix with PID
Ovarian cysts.