Background

• Endometrial polyps are hyperplastic overgrowths of the endometrial glands and stroma

• They account for nearly 30% of cases of abnormal uterine bleeding and are symptomatic in 56-88% of cases (Godoy Borges et al., 2015)

• Transvaginal ultrasound is typically used to make the diagnosis; however, its sensitivity and specificity are not ideal, with reports indicating that at least 30% of EP seen on ultrasound are not visible during hysteroscopy (Pereira et al., 2021)

•  

• Accurate diagnosis of endometrial polyps is crucial for appropriate clinical management. Discrepancies in findings between TVUS, hysteroscopy, and histopathology could lead to under- or overtreatment, unnecessary procedures, or missed diagnoses. Evaluating the concordance of these diagnostic modalities in real-world practice will help optimize patient care pathways.

• To evaluate the diagnostic accuracy of transvaginal ultrasound (TVUS) and hysteroscopy for endometrial polyps by comparing findings with histopathology results, with a focus on differences between pre- and post-menopausal women.

•  

•  

  Methodology

   

  • A retrospective review of a random sample of patients who underwent diagnostic hysteroscopy for abnormal uterine bleeding, including those with suspected endometrial polyps or a thickened endometrial lining

  • Data collected included age, menopausal status, symptomatology, ultrasound findings, hysteroscopic findings, histology results

  • Analysis of data to check concordance between ultrasound and hysteroscopic findings

  •  

  Results

  • Total of 53 patients

  •  

  •  

  •  

  •  

  •  

  •  

  •  

  •  

  •  

  •  

  •  

   

   

  •  

   

  Discussion

   

  • TVUS reliably detects polyps, particularly in premenopausal patients (23/26 confirmed on hysteroscopy).

  • TVUS, especially done between days 3-5 of cycle, in pre-menopausal women, is valuable to reduce unnecessary interventions

  • False negatives occur, as some polyps are missed (e.g., 13 cases in postmenopausal patients) but this is as high as there is a lower threshold for post-menopausal patients to undergo a hysteroscopy.

  • In premenopausal patients, TVUS done on days 3–5 improves diagnostic accuracy

  • Hysteroscopy complements TVUS by identifying polyps missed on ultrasound, ensuring better diagnostic precision.

  •  

  Limitations

   

  • Retrospective nature of the study and mall sample size (50 patients)

  • Lack of departmental consensus - different clinical approach of abnormal uterine bleeding amongst different firms

  •  

  Recommendations

  •  

  • Ensure TVUS in premenopausal patients is performed during days 3–5 of the menstrual cycle to improve diagnostic accuracy by developing a streamlined care pathway

  • Improve US training in detecting polyps to improve diagnostic accuracy

  • Development of a departmental guideline on the management of abnormal uterine bleeding including management of polyps in pre- and post-menopausal patients