Diagnostic Value of Transvaginal Ultrasonography and Hysteroscopy in Comparison With Pathology in the Detection of Endometrial Lesions in Women With Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding is a common reason for referral to gynecologic clinics. It encompasses a wide range of menstrual problems, from life-threatening bleeding to amenorrhea. This study evaluated the accuracy of hysteroscopy in diagnosing endometrial pathologies and compared it with transvaginal ultrasonography (TVU) and histopathologic reports. Methods: In this analytical cross-sectional study, premenopausal and menopausal patients were included from those attending the Obstetrics and Gynecology Outpatient Clinic at Urmia Kosar Hospital, Urmia University of Medical Sciences, from January 2021 to June 2022. The patients were recruited using a convenience sampling technique. Results: Of 111 patients, 35 (32%) were menopausal with a mean age of 50.18±3.67, and 76 (68%) were premenopausal with a mean age of 42.41±2.03 years. Most premenopausal and menopausal patients were multiparous (88.24% and 85.71%, respectively). The results demonstrated 95.31% sensitivity, 44.7% specificity, 70.1% positive predictive value (PPV), and 87.5% negative predictive value (NPV) for TVU, as well as 98.4% sensitivity, 49% specificity, 71.3% PPV, and 95.8% NPV for hysteroscopy to diagnose intracavity endometrial lesions among all patients. In our study, hysteroscopy showed the highest accuracy for the diagnosis of endometrial polyp (91%) and endometrial thickness (94%) and was more sensitive (100% and 50%, respectively) and specific (87.5% and 100%, respectively) in this process than TVU in menopausal patients. Likewise, it was more sensitive, specific, and accurate in the diagnosis of cases among premenopausal patients compared to TVU. Conclusion: Hysteroscopy remains the best option for the assessment of the endometrium owing to its established accuracy when compared to TVU, especially in menopausal women.