Association between Ultrasound Features and Histopathological Findings in Women with Abnormal Uterine Bleeding

Abstract

Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint affecting women during reproductive, perimenopausal, and post-menopausal periods. Ultrasonography is an important first-line investigation for identifying structural uterine abnormalities, whereas histopathological examination provides a definitive diagnosis of endometrial pathology. Aims: To evaluate the association between ultrasonographic features and histopathological findings in women presenting with AUB. Materials and Methods: This hospital-based observational cross-sectional study included 100 women presenting with AUB. Demographic characteristics, clinical presentations, and ultrasonographic findings were evaluated. Transvaginal ultrasonography was used to assess endometrial thickness, echotexture, focal lesions, and uterine abnormalities. Histopathological diagnoses were classified into benign, hyperplastic, pre-malignant, and malignant categories. Descriptive statistics and Pearson’s Chi-square test were used to demonstrate associations between ultrasound features and histopathological findings. Results: The majority of women belonged to the 41–50-year age group (42%). Thickened endometrium was observed in 28% of participants, while uterine fibroids were identified in 39% on ultrasound. Proliferative endometrium was the most common histopathological finding (24%), followed by endometrial hyperplasia without atypia (18%). A statistically significant association was demonstrated between endometrial thickness and histopathological diagnosis (χ2 = 36.75, P = 0.000002). Suspicious ultrasonographic findings were also significantly associated with abnormal histopathology (χ2 = 13.90, P = 0.00019). Conclusion: Increased endometrial thickness and suspicious endometrial morphology may help identify women who require further investigation. Ultrasonography is a useful initial diagnostic tool, while histopathological examination remains essential for definitive diagnosis of endometrial abnormalities.