Diagnostic accuracy of transvaginal ultrasound versus endometrial histopathology in women with abnormal uterine bleeding: A single-center experience from Saudi Arabia
Ahmed Alsayyah, Ahmed Alessa, Osama H. Alghamdi, Omar G. Alghamdi, Husam A. Alghamdi, Mostafa H. Alyousif, Abdulraheem K. Alshenqiti, Tajammal MustafaAbstract:
BACKGROUND:
Abnormal uterine bleeding (AUB) is a prevalent gynecological complaint that affects women’s quality of life and requires accurate diagnostic evaluation. Although transvaginal ultrasound (TVUS) is a noninvasive first-line imaging modality, endometrial biopsy remains the gold standard for diagnosis. However, there is no substantial evidence in Saudi Arabia of any discussion of the correlation between the endometrial biopsies of AUB and TVUS findings. Therefore, this study’s aim was to explore this gap and uncover the subtle relation between TVUS and the findings of endometrial histopathological samples.
MATERIALS AND METHODS:
A cross-sectional study was conducted at King Fahd Hospital of the University, a tertiary referral center in Al Khobar, Eastern Province, Saudi Arabia, from November 2022 to November 2025. The medical records of women with AUB who had undergone TVUS and endometrial biopsy were retrospectively reviewed. Clinical, radiological, and histopathological data were extracted and analyzed using SPSS. Histopathology was used as the gold standard for assessing TVUS diagnostic accuracy and as a guide to the appropriate management.
RESULTS:
Of the 249 participants (mean age 47.5 years), histopathology identified endometrial polyps in 38.6%, malignancies in 4.4%, and hyperplasia in 2.8%. TVUS diagnostic sensitivity was low: 24.0% for polyps, 0.0% for hyperplasia, and 9.1% for malignancy, giving slight overall agreement with histopathology (κ =0.189). Notably, 40.0% of the normal scans yielded missed abnormalities, including 4 of 11 reported malignancies (36.4%). In multivariable regression, age was the only independent predictor of significant endometrial pathologies (adjusted odds ratio 1.14 per year,
CONCLUSION:
TVUS shows low sensitivity and poor agreement with histopathology, leading to missed significant lesions such as malignancies. Thus, as normal TVUS cannot rule out disease safely, histopathology remains the gold standard.