Transvaginal sonography in postmenopausal women

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Abstract
Transvaginal sonography (TVS) is a recent addition to the diagnostic techniques available for the evaluation of the female pelvis. Our experience in over 200 cases of postmenopausal women is the subject of this synoptic review. Using this technique in 60 women, we were able to detect endometrial changes such as endometrial carcinoma or adenomatous hyperplasia in 81% and in a group of 19 patients myometrial invasion in 84%. Fibroids of different sizes and locations could be recognized, some of them with signs of cystic degenerations. In 48 postmenopausal women, TVS was used to follow the morphologic changes in the endometrium stimulated by hormone replacement therapy. Histological features of the endometrium were in close correlation with the sonographic patterns obtained. Ultrasound evaluation has been suggested as a possible screening tool for early changes in ovarian size and morphology. Fifty patients were evaluated for the effectiveness of TVS to detect ovarian pathology. The sensitivity and specificity were 83% and 100%, the same as that of gross examination of the ovary at the time of surgery. It seems that TVS is a reliable tool in the detection of early changes in the postmenopausal ovary, but further evaluation in a large population is necessary to assess the usefulness of TVS as a routine screening tool for early ovarian carcinoma. Twenty‐nine postmenopausal women with unilateral simple cysts (diameter ≤ 5 cm) were identified. All exhibited benign histopathologic changes. We conclude that small (<5 cm) postmenopausal cysts have a low incidence of malignancy and could be followed by TVS without immediate surgical intervention. Local recurrences in gynecologic neoplasms were evaluated in 21 postmenopausal women after previous surgery, radiation, and chemotherapy in cases of endometrial, cervical, and ovarian carcinomas. Using the criteria of malignant mass at the cranial end of the vagina and the size of vaginal vault, the TVS demonstrated recurrency with a sensitivity of 100%, specificity of 83%, and overall occurrence of 90.4%. Identifying and characterizing cul‐de‐sac fluid is also greatly facilitated with TVS. Differentiation of clear serous fluid from hemorrhagic or exudative fluid by identifying echoes or septations within the fluid is possible. These fluid characteristics may be helpful in the detection of postradiation fibrosis, pelvic inflammatory diseases, and ovarian malignancy, and may provide additional diagnostic clues to an otherwise nonspecific pelvic mass. Finally, carcinoma of the urinary bladder could be detected early by TVS and this technique should be an integral part of the ultrasound examination in all who are suspected of bladder carcinoma.