<b>Accuracy of Transvaginal Ultrasound (TVS) and Hysteroscopic Examination in Detecting the Causes of Abnormal Uterine Bleeding (AUB)</b>

Background: Abnormal uterine bleeding is a common gynecological problem among reproductive-age and perimenopausal women and may result from structural intrauterine abnormalities such as endometrial polyps, submucosal fibroids, hyperplasia, or malignancy. Accurate diagnosis is essential for appropriate management, avoidance of unnecessary invasive procedures, and timely detection of clinically significant pathology. Objective: To evaluate and compare the diagnostic accuracy of transvaginal ultrasound and hysteroscopic examination in detecting causes of abnormal uterine bleeding, using histopathology as the reference standard. Methods: This cross-sectional comparative diagnostic accuracy study included 100 women presenting with abnormal uterine bleeding at the Radiology Department of Dr. Essa Laboratory and Diagnostic Centre, Lahore. Participants were selected using non-probability consecutive sampling. All participants underwent transvaginal ultrasound followed by diagnostic hysteroscopy, and findings were compared with histopathological diagnosis. Data were analyzed using SPSS version 25, and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: Most participants were aged 36–50 years. Heavy menstrual bleeding was the most common presentation. Histopathology identified endometrial polyp as the most frequent diagnosis, followed by fibroid and malignancy. For detecting endometrial polyps, transvaginal ultrasound showed sensitivity of 40.0%, specificity of 90.0%, PPV of 80.0%, NPV of 60.0%, and accuracy of 65.0%. Hysteroscopy demonstrated higher sensitivity of 56.0%, specificity of 96.0%, PPV of 93.3%, NPV of 68.6%, and accuracy of 76.0%. Conclusion: Hysteroscopy showed superior diagnostic performance compared with transvaginal ultrasound for detecting focal intrauterine pathology, particularly endometrial polyps. Transvaginal ultrasound remains useful as a first-line, non-invasive screening tool, while hysteroscopy with biopsy should be considered when ultrasound findings are inconclusive or focal pathology is suspected.