ACCURACY OF TRANSVAGINAL SONOGRAPHY IN DETECTING ENDOMETRIAL ABNORMALITIES IN WOMEN WITH PERI AND POSTMENOPAUSAL BLEEDING

Background: In most women with peri n post menopausal bleeding have non malignant endometrial changes. However’ uterine currettage is mandatory to exclude malignant changes. Diagnostic curretage has been the method of choice for many years to diagnose cancer of endometrium in patients with post menopaual bleeding. Although it is a simple technique, however it is an invasive and uncomfortable procedure and not without danger. For this reason many different methods have been developed to minimize the need of currettage. Trans-vaginal sonography and color doppler of uterine artery have shown good accuracy in detecting normal endometrium from abnormal. Objectives: Aim of this work is to evaluate the role of TRANS VAGINAL SONOGRAPHY study of endometrium and Doppler velocimetric measurement of uterine artery as non invasive screening procedures to detect endometrial pathology in peri n post menopausal bleeding and to correlate the sonographic results with hispathological finding in order to discriminate normal from pathological endometrium. Methodolgy: This study was carried out in Department of Obstetrics and Gynaecology with collaboration of Department of Pathology and Department of Radiology. 100 patients were selected and they were presented with chief complaints of peri and post menopausal bleeding and subjected to Trans-vaginal sonography, color Doppler n diagnostic curettage. The data obtained from the ultrasound and Doppler examinations is compared to the results of the Histopatholigical Diagnosis After currettage. Results: In this study, women with peri and post menopausal bleeding and an abnormal endometrium was: 7.36±3.225mm n 12.54±4.64 as compared to ET thickness in normal group. 6.72+1.25 and 5.05+1.148 mm, with a p- value of less than .001 which is statistically significant. AT cut off pt. off 6mm in peri menopausal gp. Sensitivity n specificity was seen 83.3% percent n 78.2 percent respectively and at cut off pt. of 4mm in post menopausal group. Sensitivity n specificity was 87.5% and 77.3% which was highest in my study. These were the best cut off point values in my study where maximum sensitivity and specificity was achieved. Also the values of resistance index and pulsatality index of uterine artery in normal benign group was higher than abnormal group. Resistance index of normal group was 85+0.36 and abnormal group was 0.73+0.78 and for pulsatality index were 3.88+0.43 and 1.65+1.17 shows that levels were significantly lower in patients with abnormal endometrium. For resistance index best cut off point of uterine artery was at 0.83 where sensitivity and specificity was 92.3% and 66.67% respectively and for pulsatility index of uterine artery was at 3.80 where sensitivity n specificity are92.6% n 73.9%.which was maximum in this study. Conclusion: This study showed that patients with abnormal endometrial pathology had a mean endometrial thickness that was significantly higher than patients with normal endometrium. And similarly Doppler indices showed levels that were significantly lower in patients with abnormal endometrial pathology. Both transvaginal sonography endometrial thickness n doppler velocimetric study of uterine artrey posses high sensitivity and specificity that makes each of them clinically useful as a single screening tool in discriminating normal from abnormal pathological endometrium in cases with peri and post menopausal bleeding. Yet the present study emphasizes the importance of combined techniques to increase screening accuracy.