Prediction of benign and malignant endometrial disease: hysterosonographic-pathologic correlation

To determine the transvaginal hysterosonographic appearances of benign and malignant endometrial disease.

From April 11, 1994, through August 1, 1996, a total of 88 women (age range, 25-81 years) underwent transvaginal hysterosonography and histopathologic evaluation of the endometrium after dilation and curettage or after hysterectomy. A benign appearance at transvaginal hysterosonography was defined as a thin endometrium, diffuse smooth endometrial thickening, or a smoothly marginated, homogeneously echogenic, pedunculated endoluminal mass. A suspicious appearance was defined as either irregular thickening of the endometrium or an inhomogeneous endoluminal mass.

Of 88 women, 37 had a benign-appearing endometrium at transvaginal hysterosonography; at histologic examination, 16 had a proliferative endometrium, 12 had a secretory endometrium, six had polyps, two had an inactive endometrium, and one had carcinoma. Of the 51 women with suspicious endometrial appearances, eight had carcinoma, 24 had adenomatous polyps, five had hyperplasia, 11 had fibroids, and three had endometritis. For carcinoma, the sensitivity of transvaginal hysterosonography was 89%, specificity was 46%, positive predictive value was 16%, and negative predictive value was 97%.

A thin endometrium or diffuse smooth endometrial thickening is predictive of benign endometrial histologic findings, but all women with endoluminal masses require further histologic evaluation to exclude malignant disease.