Estudo da acurácia da ultra-sonografia transvaginal na avaliação da cavidade endometrial de 31 pacientes menopausadas assintomáticas em correlação com achados histeroscópicos e anatomopatológicos

Abstract

This study had the objective to evaluate the performance of vaginal ultrasound and hysteroscopy as tests of endometrial evaluation, in a group of 31 pôs menopausal patients of the Gynecology Sector of Maternidade Escola Assis Chateaubriand-UFC considering the histological findings as the gold standart. The study was prospective one, in the period of abril 2005 to November 2005. Were included patients in amenorrhea of at least one year duration and FSH levels over 40 mUI/ml. Were excluded hysterectomized patients, patients with transvaginal bleeding and those that did not did vaginal ultrasound and hysteroscopy. The vaginal ultrasound data evaluate were: endometrial thickness, regularity and ecogenicity. These data were analyzed through the receiver operator characteristic curve (ROC), Kappa coefficient, t Student test for correlation of nonnal variables and Test of Mann-Whitney for abnormal distribution variables. The most frequent hysteroscopic findings was atrophic endometrium, in 61.2% of cases. Edometrial polyps were found in 19.4% of cases, and myomas in 12.9% and thickened endometrium in 6.5%. Concerning the vaginal ultrasound findings, the most common findings was atrophic endometrium in 24 patients, 77.4% of cases, thickened endometrium in two cases, 6.4%, endometrial polyp in one patient, 3.2% and myoma in 12.9%. Concerning the histological findings, the most common findings was atrophic endometrium, 64.5% of cases. Endometrial polyps m 16.1% of cases, myomas in 12.9%, proliferative endometrium in 3.2% e hyperplasic endometrium in 3.2% of patients. Taking in account the prevalence of endometrium alterations in the pos menopausal period of 30%, the sensitivity of the vaginal ultrasound to detect endometrium alterations was of 63.7%, the specificity was 100%, the positive predictive value was of 100% and the negative predictive value was of 83.3% with an accuracy of 89%. In the group of patients the possibility that a negative diagnosis can occur is 2.75 times than to have the same diagnosis in a group of patients with endometrium alterations. We conclude that vaginal ultrasound is a good screening test in pos menopausal asymptomatic patients