Endometrial Volume as a Predictor of Endometrial Pathology in Perimenopausal Uterine Bleeding

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Background: Transvaginal ultrasonography (TVS) imaging is aroutine, non-invasive procedure in initial evaluation of patients withabnormal uterine bleeding in perimenopausal age. However, there isno yet a cutoff value to discriminate benign form malignant cases.Aim of the Work: Is to assess the potential value of endometrialvolume measurements by 2D TVS compared with that of endometrial thickness in prediction of different endometrial pathologies inwomen with perimenopausal uterine bleeding.Patients and Methods: Ninety-two perimenopausal women presented with uterine bleeding were enrolled to the study after exclusionof general and local caused of bleeding as polyps and fibroids. TVS(2D) was done to measure endometrial thickness and volume using aspecific formula. Endometrial biopsy was taken and the pathologicalresults was correlated with the endometrial thickness and volume.Results: There was a statistically noticeable difference between benign endometrial pathology compared to endometrial hyperplasiawith atypia or endometrial carcinoma as regard age as well as bodymass index. There was a high statistically significant difference between patients with benign endometrium pathology and malignantendometrial pathology regarding endometrial thickness and volume.That endometrial volume had a high predictive value as proved byan area under the ROC curve (AUC) of 0.826. The best cut-off valuewas an endometrial volume >11.675 cm3. While (ROC) curve analysis for differentiation of patients using endometrial volume and endometrial thickness into women with benign endometrial pathologyor hyperplasia and those with endometrial carcinoma; Endometrialvolume also had a higher predictive value than endometrial thicknessas proved by an area under the ROC curve (AUC) of 0.871. Thecut-off value was an endometrial volume >13.105 cm3. While usingendometrial thickness cut-off value was an endometrial thickness >14.5mm.Conclusion: endometrial volume measured with inexpensive 2DTVS has a higher predictive value than measuring endometrial thickness in correspondence to the pathological results in patients withperimenopausal bleeding.