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Previous Volume 337:1792-1798 December 18, 1997 Number 25 Next

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ABSTRACT

Background Transvaginal ultrasonography is a noninvasive procedure that may be used to detect endometrial disease. However, its usefulness in screening for asymptomatic disease in postmenopausal women before or during treatment with estrogen or estrogen–progesterone replacement is not known.

Methods We compared the sensitivity and specificity of transvaginal ultrasonography and endometrial biopsy for the detection of endometrial disease in 448 postmenopausal women who received estrogen alone, cyclic or continuous estrogen–progesterone, or placebo for three years.

Results Concurrent ultrasonographic and biopsy results were available for 577 examinations in the 448 women, 99 percent of whom were undergoing routine annual follow-up. Endometrial thickness was less than 5 mm in 45 percent of the examinations, 5 to 10 mm in 41 percent, more than 10 mm in 12 percent, and not measured in 2 percent, and it was higher in the women receiving estrogen alone than in the other groups. Biopsy detected 11 cases of serious disease: 1 case of adenocarcinoma, 2 cases of atypical simple hyperplasia, and 8 cases of complex hyperplasia. Biopsy also detected simple hyperplasia in 20 cases. At a threshold value of 5 mm for endometrial thickness, transvaginal ultrasonography had a positive predictive value of 9 percent for detecting any abnormality, with 90 percent sensitivity, 48 percent specificity, and a negative predictive value of 99 percent. With this threshold, a biopsy would be indicated in more than half the women, only 4 percent of whom had serious disease.

Conclusions Transvaginal ultrasonography has a poor positive predictive value but a high negative predictive value for detecting serious endometrial disease in asymptomatic postmenopausal women.

Source Information

From the Department of Family and Preventive Medicine, University of California, San Diego, La Jolla (R.D.L.); the Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, N.C. (J.J.P., M.A.E.); the Department of Gynecology and Obstetrics, Stanford University, Palo Alto, Calif. (K.A.O.); the College of Medicine, University of Iowa, Iowa City (S.R.J.); the Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio (J.F.T.); the Department of Obstetrics and Gynecology, George Washington University Medical Center, Washington, D.C. (V.M.B.); the National Cancer Institute, Bethesda, Md. (M.J.M.); and the Pathology Department, Massachusetts General Hospital, Boston (R.E.S.).

Address reprint requests to Dr. Langer at the University of California, San Diego, 9500 Gilman Dr., MC 0978, La Jolla, CA 92093-0978.

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