Transvaginal Sonography and Endometrium

Galal Lotfi. MD, MRCOG

Professor Obstetrics & Gynecology
Suez Canal University
Egypt

Aim Of Work
To stydy the efficacy of TVS in
dignosing abnormal
Endometrial pattern in
postmenopausal women

Introduction

Screening Methods Include:

Pap Smear; specificity and
sensitivity
Endometrial cytology
Office Biopsy; Clinical and
technical difficulties
D&C add anestetic hazards and
limitations

Drawbacks
Smear:

lack of specificity and sensitivity

Endometrial cytology: Clinical and technical
difficulties
Office Biopsy; Clinical and technical difficulties
D&C: Invasive, Costly, Anesthesial

Design
Antrospective

study for
Postmenopausal women,
without or with
postmenopausal bleeding

Material and Methods

Postmenopausal

women
with no bleeding , n=187
Postmenopausal women
with bleeding, n=132.

Material and Methods, cont..

All

women were subjected to

TVS

for pelvic assessment and

endometrial thickness measurement
Pap smea
D&C biopsy

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

group

woen without bleeding n=187

Ia: high risk group n=72

group Iib: low risk group n=60

Risk Factors:
Diabetes
Hypertension
Obesity
Previous

abnormal smea

PCO
Family

History

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
31
117
25.3 <0.005
=<4mm
Endometrial thickness
7
8
1.4
NS
>4<8mm
Endometrial thickness
12
5
12.7 <0.005
>8<12mm
Endometrial thickness >12 6
1
8.3
<0.005
Total
56
131

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
31
117
25.3 <0.005
=<4mm
Endometrial thickness
7
8
1.4
NS
>4<8mm
Endometrial thickness
12
5
12.7 <0.005
>8<12mm
Endometrial thickness >12
6
1
8.3
<0.005
Total
56
131

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
28
37
6.8
<0.005
=<4mm
Endometrial thickness
11
10
0.05 0.8
>4<8mm
Endometrial thickness
20
9
11.1 <0.005
>8<12mm
Endometrial thickness >12 13
4
3.7
0.05
Total
72
60

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

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

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

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

RESULTS

TVS:

Delineate the endometrium

Measures the endometrila thickness
Detects associated endometrial
pathology
Detects other pathology in the pelvis

Other pathology detected

Endometrila polyps
Samall fibroid
Adenomyosis
Hydrosaplix with PID
Ovarian cysts.