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The comparison of transvaginal ultrasonography and hysteroscopy in women with abnormal uterine bleeding: A single center experience

Aim: The aim of this study is to compare the diagnostic accuracy of transvaginal ultrasonography and hysteroscopy in the detection of intracavitary abnormalities that presented with abnormal uterine bleeding. 
Material and Methods: 216 women with uterine bleeding involve in this study. In this retrospective study, the diagnostic accuracy of transvaginal ultrasonography and hysteroscopy were compared to their corresponding pathology results in both prepostmenopausal (n:145) and postmenopausal (n:71) women. To compare these three methods more reliably, we used Kappa analyses. 
Results: In postmenopausal group with endometrial polyp and myomas; sensitivity of transvaginal ultrasonography is 68.2% to 40% dilatation & curettage, specificity is 33.3% to 97% and Kappa value is 0.016 to 0.407. Sensitivity of hysteroscopy is 97.7% to 40% dilatation & curettage, specificity is 74.1% to 100% and Kappa values is 0.75 to 0.553. Specificity of transvaginal ultrasonography is 98.3% to hysteroscopy, specificity of transvaginal ultrasonography is 98.1% to dilatation & curettage, sensitivity of hysteroscopy is 47.1% and specificity is 90.7% to dilatation & curettage and Kappa value is 0.411 with normal patients in the same group. 
Conclusion: In postmenopausal patients transvaginal ultrasonography has a high chance of detecting when there is an endometrial pathology. Transvaginal ultrasonography is not sensitive enough to use solely in order to exclude polyps and fibroids in abnormal uterin bleeding. Therefore, hysteroscopy can be applied even if transvaginal ultrasonography is normal in these patients.