IS THE USE OF TRANSVAGINAL ULTRASOUND BENEFICIAL IN THE POST-MENOPAUSAL BLEEDING PATHWAY? – ASSESSING THE DIAGNOSTIC VALUE OF ULTRASOUND IN SCREENING
By Danielle Styles, Hull University Teaching Hospitals
This research study retrospectively reviewed the ultrasound and subsequent hysteroscopy results in order to determine the sensitivity and specificity of transvaginal ultrasound in the screening of patients who experience post-menopausal bleeding to determine the probability of them having an endometrial malignancy.
Women who experience post-menopausal bleeding who are seen by their General Practitioner are referred to the ultrasound department in Trust A for a transvaginal ultrasound scan. The primary aim of this is to measure the endometrial thickness. Trust A’s current guidelines state that anteroposterior endometrial measurements greater than 4mm in post-menopausal patients are abnormal and are to be referred for a hysteroscopy where a biopsy of the endometrial stroma is taken and assessed for malignant cells.
The study found that out of the 863 referred on this pathway only 7 patients were found to have completely normal endometrial thickness measurements and were referred back to their primary care physician. A number of patients were referred directly to hysteroscopy due to contraindications or scan limitations but a total of 759 were found to have an abnormally thickened endometrium for post-menopausal status. Out of these patients, 488 had normal biopsy results with no evidence of atypia, hyperplasia or malignancy.
As it has shown to provide little diagnosis value in separating a normal endometrial lining from abnormal, it raises the questions as to whether there is the potential to abolish the ultrasound scan and refer all patients who experience post-menopausal bleeding directly to the hysteroscopy service for review. While the results of the study discredits the use of transvaginal ultrasound in the screening of patients who experience post-menopausal bleeding, this has the potential to reduce demand on the ultrasound service and is a worthy trade-off between avoiding unnecessary invasive tests for the few patients with normal ultrasound results, and streamlining the overall pathway.