Comparative Study of Transvaginal Ultrasonography versus Histopathological Examination in Evaluation of Endometrial Pathologies

Background: Transvaginal ultrasonography (TVS) has emerged as an invaluable, non-invasive tool in the primary evaluation of endometrial pathology. However, histopathological examination remains the gold standard for definitive diagnosis. A systematic comparison of the two modalities is essential for optimizing clinical management of endometrial disorders.Objectives: To assess the diagnostic accuracy of TVS in identifying endometrial pathologies by comparing TVS findings with histopathological diagnoses, and to determine optimal endometrial thickness (ET) cutoffs for predicting significant endometrial pathology. Materials and Methods: A prospective cross-sectional study was conducted over 18 months at the Department of Obstetrics & Gynaecology, Armed Forces Hospital, Pune, Maharashtra. Sixty-two women presenting with abnormal uterine bleeding, postmenopausal bleeding, or suspected endometrial pathology were enrolled. All patients underwent TVS followed by endometrial sampling (hysteroscopy-guided biopsy or dilatation and curettage). TVS findings were compared with histopathological reports. Results: The mean age of participants was 48.4 ± 10.2 years. TVS demonstrated an overall sensitivity of 87.1%, specificity of 92.5%, positive predictive value (PPV) of 83.8%, negative predictive value (NPV) of 94.6%, and diagnostic accuracy of 91.2% when compared with histopathology. TVS-histopathology concordance was observed in 48 of 62 cases (77.4%). Endometrial carcinoma detection showed the highest specificity (96.3%). An endometrial thickness cutoff of >4 mm in postmenopausal women yielded 91.7% sensitivity and 87.5% specificity. Conclusion: TVS is a reliable, highly accurate, and cost-effective screening tool for endometrial pathology. While it cannot replace histopathological examination, TVS serves as an excellent triage modality to identify patients requiring further invasive evaluation