Correlation of Ultrasound, Hysteroscopy, and Histology in Postmenopausal Women: A Five-Year Retrospective Observational Study in Dubai

Introduction This study investigates the relationship between endometrial thickness measured by ultrasound, hysteroscopic findings, and histological diagnosis of endometrial pathology. It aims to evaluate the diagnostic efficacy of ultrasound and hysteroscopy in detecting endometrial malignancy in postmenopausal women and in high-risk groups such as breast cancer patients on tamoxifen. Methods This retrospective observational study was conducted at Dubai Hospital between January 2018 and December 2022. Ethical approval was obtained from the Dubai Scientific Research Ethics Committee. Histopathology was used as the reference (gold) standard for all calculations of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results A total of 168 post-menopausal patients were analyzed. The mean age of the participants was 59.39 ± 7.825 years (range: 44-86 years). The mean body mass index was 34.60 ± 7.60 kg/m², with 73.1 % of participants obese and 19.6% morbidly obese. The mean duration of menopause was 8.220±6.66 years. A total of 132 (78.6%) participants presented with postmenopausal bleeding. The mean endometrial thickness was 11.084 ± 6.19 mm. The frequency of endometrial cancer increased with endometrial thickness, with malignancy identified in 0 of 19 cases (<5 mm), 3 of 72 cases (4.2%; 5-10 mm), 1 of 46 cases (2.2%; 10.1-15 mm), and 1 of 20 cases (5.0%; 15.1-20 mm); notably, the highest malignancy rate was observed in the >20 mm group, where 5 of 11 cases (45.5%) were malignant, although this subgroup represented the smallest proportion of the cohort (6.5%). Benign polyps (90; 53.5%) were the most common histopathological findings. Endometrial carcinoma was diagnosed in 10 (6.0%) of cases and endometrial hyperplasia in 11 (6.5%) cases. At the threshold of≤ 5 mm, ultrasound had a sensitivity of 100%, specificity of 12%, PPV of 67%, and NPV of 100%. Hysteroscopy showed sensitivity of 80%, specificity of 96.2%, PPV of 57.1%, and NPV of 98.7%. In post-menopausal breast cancer patients, the mean endometrial thickness was 11.361 ± 5.079 mm. No cases of endometrial cancer were identified in the breast cancer cohort. Conclusion Transvaginal ultrasound is a reliable first-line investigation for postmenopausal bleeding, with high sensitivity but limited specificity. Hysteroscopy provides high specificity and the ability to obtain biopsies.