Postmenopausal bleeding: A diagnostic approach for both private and public sectors
Date
2006
Authors
Spicer J.M.
Siebert I.
Kruger T.F.
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Abstract
Objective: To assess the optimal diagnostic approach to women with postmenopausal bleeding by comparing transvaginal ultrasound and endometrial sampling with office hysteroscopy. Methods: A prospective collective study was performed on 102 consecutive patients with postmenopausal bleeding who were evaluated by ultrasound measurement of the endometrial thickness (EL), endometrial sampling by Accurette® and outpatient hysteroscopy and directed biopsy. Results: Accurette was inadequate for histological diagnosis in 65 of 136 samples and many repeat investigations were required. In all 16 cases of endometrial polyps, ultrasound measurement of the EL was ≥4 mm and hysteroscopy confirmed the findings. Accurette detected only 5 polyps. All 7 cases of endometrial hyperplasia were detected using an EL of ≥4 mm and hysteroscopy confirmed the findings. Accurette failed to detect 5 out of 7 cases of endometrial hyperplasia. Five cases of endometrial cancer were diagnosed: all had an EL ≥4 mm but were inadequately sampled for diagnostic purposes in 3 cases. A definitive diagnosis was made on hysteroscopy in 4 cases (1 patient did not have a hysteroscopy). Conclusion: Accurette is not a good sampling device for the diagnosis of postmenopausal bleeding. An ultrasound measurement of the EL ≥4 mm in patients with postmenopausal bleeding warrants further investigation. Outpatient office hysteroscopy is an accurate and sensitive modality to employ as a first line investigation for definitive diagnosis. Copyright © 2006 S. Karger AG.
Description
Keywords
adult, aged, article, bleeding, controlled study, diagnostic accuracy, diagnostic procedure, echography, endometrium, endometrium cancer, endometrium hyperplasia, endometrium polyp, female, human, human tissue, hysteroscopy, intermethod comparison, major clinical study, menopausal syndrome, organization and management, outpatient, postmenopause, priority journal, sensitivity and specificity, transvaginal echography, uterus biopsy, Adenocarcinoma, Aged, Aged, 80 and over, Biopsy, Endometrial Hyperplasia, Endometrial Neoplasms, Female, Humans, Hysteroscopy, Middle Aged, Mixed Tumor, Mullerian, Polyps, Postmenopause, Private Sector, Prospective Studies, Public Sector, Sensitivity and Specificity, South Africa, Ultrasonography, Interventional, Uterine Diseases, Uterine Hemorrhage
Citation
Gynecologic and Obstetric Investigation
61
3
61
3