Authors' reply re: Diagnostic work up for postmenopausal bleeding: a randomised controlled trial

Hanegem, Nehalennia van; Timmermans, Anne; Mol, Ben Willem J.; Breijer, Maria

doi:10.1111/1471-0528.14286

Cited by 1 publication

(6 citation statements)

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“…The other studies excluded failed procedures because they were looking for a conclusive SCSH examination as their outcome parameter. The success rate was 80-93% based on these two studies 4,20 . The most common reason for procedure failure was cervical stenosis.…”

Section: Failed Proceduresmentioning

confidence: 90%

“…The characteristics of the five included studies are described in Table 2. The study of Bingol et al 19 used histopathology as a reference standard and the studies of van Hanegem et al 4 and Epstein et al 20 used polyps seen on hysteroscopy as a reference standard. The studies of Cohen et al 21 and Karageyim Karsidag et al 22 described both techniques separately and, therefore, could be used in both analyses of diagnostic accuracy.…”

Section: Diagnostic Accuracy To Detect Polypsmentioning

confidence: 99%

“…Failed procedures were described in only two studies 4,20 . The other studies excluded failed procedures because they were looking for a conclusive SCSH examination as their outcome parameter.…”

Section: Failed Proceduresmentioning

confidence: 99%

“…Three studies provided data using histopathology as the reference standard 19,21,22 , while four provided data using 'polyps seen on hysteroscopy' as the reference standard 4,[20][21][22] . We performed analyses separately for each reference standard, first, in order to exclude the risk of bias when these standards were combined in the analysis and, second, because we were mainly interested in the performance of SCSH compared with the reference standard used to make clinical decisions, namely hysteroscopy.…”

Section: Reference Standardsmentioning

confidence: 99%

“…About 40% of women with PMB and a thickened endometrium have endometrial polyps 2,3 . The risk for a focal (pre)malignancy in an endometrial polyp in women with PMB is 4.47-6% 4,5 . Because of this risk, it is important to detect polyps in women with PMB.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta‐analysis

Vroom

Timmermans²,

Bongers

et al. 2019

Ultrasound in Obstet & Gyne

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Objective In women with postmenopausal bleeding, endometrial polyps are a frequent finding and the risk of a focal (pre)malignancy in a polyp is up to 6%. Because of this reported risk, the detection of polyps in these women, preferably by a minimally invasive method, is important. The aim of this systematic review was to assess the accuracy of saline contrast sonohysterography (SCSH) for diagnosis of endometrial polyps in women with postmenopausal bleeding. Methods In August 2018, an electronic search was performed of MEDLINE, EMBASE and Web of Science databases to identify all diagnostic studies in which SCSH was used to detect endometrial polyps in postmenopausal women. Studies were included if SCSH was performed to detect endometrial polyps in women with postmenopausal bleeding and if detection of a polyp on hysteroscopy or diagnosis on histopathology was used as a reference standard. Two reviewers assessed methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS‐2) tool. Two separate analyses were performed for each reference standard. Pooled sensitivity and specificity were calculated using the hierarchical summary receiver–operating characteristics (HSROC) model and HSROC curves were plotted. Results After selection and quality assessment, five studies were included. Using ‘polyps diagnosed with histopathology’ as the reference standard, the pooled sensitivity of SCSH was 86.5% (95% CI, 63.6–100%) and the pooled specificity was 91.1% (95% CI, 63.2–100%). Using ‘polyps seen on hysteroscopy’ as the reference standard, the pooled sensitivity of SCSH was 85.1% (95% CI, 66.9–100%) and the pooled specificity was 84.5% (95% CI, 68.1–100%). Excluding the one study that included women in whom the SCSH examination was reported to be suboptimal, the pooled sensitivity increased to 90.7% (95% CI, 72.8–100%) using hysteroscopy as the reference standard. The sensitivity of hysteroscopy to detect polyps, as reported in two studies, was 81–98%. Conclusions Provided that the SCSH examination is of optimal quality, it can be considered as a method to stratify women with postmenopausal bleeding for further diagnostic workup and treatment with hysteroscopy. In women without suspicion of a polypoid lesion on SCSH, and with a benign endometrial sample, expectant management should be considered. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Failed Proceduresmentioning

confidence: 90%