Diagnostic value of transvaginal sonography versus hysteroscopy in patients with endometrial polyps

Endometrial polyps (EPs) are prevalent benign intrauterine growths linked to abnormal uterine bleeding and a potential risk of malignancy. While transvaginal sonography (TVS) is commonly used as a non-invasive screening method, its diagnostic performance varies depending on patient characteristics. Hysteroscopy (HSC), although more invasive, remains the gold standard for EP diagnosis. In this prospective cohort study involving 80 patients with suspected EPs, both TVS and HSC were performed to evaluate their diagnostic accuracy. Overall, HSC demonstrated superior accuracy (95.0% vs. 82.5%), specificity (94.4% vs. 72.2%), and area under the curve (0.94 vs. 0.79) compared to TVS. The sensitivity of TVS was significantly lower in postmenopausal women (66.7%) than in perimenopausal women (86.8%). For polyps smaller than 1.5 cm, TVS also showed markedly reduced sensitivity compared to HSC. However, TVS performance improved in cases with endometrial thickness no less than 8 mm. These findings suggest that while TVS is a useful first-line tool, especially for perimenopausal women or those with thickened endometrium, HSC provides higher diagnostic accuracy and should be prioritized in cases involving postmenopausal status or smaller polyps.