Role of Transvaginal Ultrasonography in Predicting Endometrial Carcinoma in Women with Postmenopausal Bleeding

Background: Postmenopausal bleeding (PMB) is a critical clinical symptom that warrants thorough evaluation to exclude endometrial carcinoma.Transvaginal ultrasonography (TVS) is widely used as a firstline diagnostic tool, but optimal cut-off thresholds for malignancy prediction remain variable across populations.This study aimed to evaluate the diagnostic performance of TVS in predicting histopathologically confirmed endometrial carcinoma in women with PMB.Methods: A cross-sectional study was conducted at Dhaka Medical College Hospital from June 2022 to May 2023 among 65 postmenopausal women presenting with vaginal bleeding.All participants underwent TVS to measure endometrial thickness (ET), followed by endometrial sampling for histopathological confirmation.Diagnostic performance metrics of TVS were calculated at a threshold of 13.5 mm.Results: Endometrial carcinoma was histologically confirmed in 6 cases (9.2%).TVS correctly identified all 6 cases (100% sensitivity) and 51 of 59 non-carcinoma cases (86.44% specificity).The positive predictive value was 42.86%, and the negative predictive value was 100%.The diagnostic accuracy was 87.69%, and the area under the ROC curve was 0.935 (95% CI: 0.875-0.995,p < 0.001).Conclusion: TVS with an endometrial thickness threshold of 13.5 mm demonstrates excellent diagnostic performance in predicting endometrial carcinoma and can serve as an effective, non-invasive triage tool in evaluating postmenopausal bleeding.