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Abstract
Background: Abnormal uterine bleeding (AUB) is a common gynecological presentation with a wide spectrum of underlying etiologies. Transvaginal ultrasound is a non-invasive procedure, while histopathological examination is considered the gold standard for evaluating endometrial pathologies. This study correlated endometrial thickness observed on transvaginal ultrasound with histopathological findings in patients with AUB.
Methods: The present study was a hospital-based prospective, cross-sectional study conducted in the Department of Pathology, Lahore General Hospital, Lahore, over 12 months from May 2024 to April 2025. Transvaginal ultrasonography and endometrial biopsy were performed in 70 women presenting with AUB. Endometrial thickness was categorized into five groups (<4 mm, 4-10 mm, 11-15 mm, 16-20 mm, and >20 mm), and histopathological outcomes were classified into eight diagnostic categories. Chi-square tests, ANOVA, and Pearson correlation were used for analysis.
Results: The most common diagnoses were endometrial hyperplasia (21.4%), endometrial polyp (20.0%), and secretory endometrium (17.1%), while endometrioid adenocarcinoma was found in 11.4% of patients. A significant association was observed between endometrial thickness category and histopathological diagnosis (p < 0.001). All cases with thickness >20 mm were diagnosed with endometrioid adenocarcinoma. Mean thickness values were significantly higher in hyperplastic and malignant cases (p < 0.001). Pearson correlation analysis showed a weak but statistically significant positive relationship between endometrial thickness and histopathological severity (r = 0.275, p < 0.05).
Conclusion: Endometrial thickness measured by transvaginal ultrasonography demonstrates a reliable correlation with underlying histopathological patterns in AUB. Thickness >11 mm, and particularly >20 mm, should undergo histological evaluation as they have high suspicion of hyperplasia or malignancy