Evaluation of endometrial thickness with transvaginal ultrasonography and histopathology in premenopausal women with abnormal vaginal bleeding

Objective: This study was undertaken to investigate cut-off value of the endometrial thickness by transvaginal ultrasonography (TvUSG), and to detect the accuracy of preoperative Pipelle biopsy in premenopausal women with abnormal vaginal bleeding. Study design: This study was included 144 premenopausal women with abnormal bleeding. Their endometrial thickness was measured by TvUSG and then Pipelle endometrial biopsy was performed. Preoperative histopathologic findings of 57 women who were operated were compared with final histolopathologic examination. Results: Of the 144 women, 113 (78.4%) had normal and 31 (21.6%) had an abnormal endometrium. The abnormal endometrium was composed of 11.8% hyperplasia (simple + atypical complex), 4.2% endometrial polyp, and 5.5% adenocarcinoma. An optimal sensitivity and specificity (83.6 and 56.4%, respectively) and negative predictive value with 95.6% for detection of abnormal endometrium were obtained with an endometrial thickness of 8 mm. The accuracy rate of preoperative Pipelle biopsy was 94.7% in a total of 57 women. Conclusion: An endometrial thickness >8 mm is more likely than that of 8 mm or less to be indicated with endometrial biopsy in premenopausal uterine bleeding. Pipelle endometrial biopsy is an accurate diagnostic procedure for the detection of high-grade endometrial lesions in premenopausal women. © 2009 Springer-Verlag.