Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding

Goldstein, Steven R.; Nachtigall, Margaret J.; Snyder, Jon R.; Nachtigall, Lila E.

doi:10.1016/s0002-9378(11)90683-8

Cited by 269 publications

(96 citation statements)

References 3 publications

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“…[6][7][8] Nevertheless, since vaginal bleeding is a common symptom among postmenopausal women, ultrasound has been a useful screening method for determining which symptomatic patients should undergo invasive collection of endometrial samples. In this situation, endometrial thickening, as measured by ultrasonography, correlates better with the presence of endometrial lesions [9][10][11] than among asymptomatic women.…”

Section: Introductionmentioning

confidence: 89%

Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women

et al. 2007

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CONTEXT AND OBJECTIVES: Endometrial cancer is the most prevalent type of malignant neoplasia of the genital tract. The objective of this study was to calculate the sensitivity, specificity, accuracy and positive and negative predictive values for diagnostic hysteroscopy, in comparison with histopathological tests, for all lesions of the endometrial cavity. DESIGN AND SETTING: Retrospective descriptive study at the public tertiary-level university hospital of Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. METHODS: Diagnostic hysteroscopy was indicated in the following instances: endometrial thickness > 4 mm in asymptomatic patients; postmenopausal bleeding; and irregular endometrium or endometrium difficult to assess from ultrasound, with or without vaginal bleeding. Ultrasound evaluations were carried out no more than three months prior to hysteroscopy. RESULTS: There were 510 patients, with a mean age of 61.1 ± 2.0 years and mean time elapsed since the menopause of 12.7 ± 2.5 years. Endometrial biopsies were performed on 293 patients (57.5%). Histopathological analysis showed that 18 patients presented endometrial carcinoma or typical or atypical hyperplasia, and none of them presented endometrial thickness of less than 8 mm. No significant differences were found between the median thicknesses of the various benign lesions (p > 0.05). In our data, the sensitivity, specificity, accuracy and positive and negative predictive values for cancer or hyperplasia were 94.4%, 97.0%, 96.8%, 68% and 99.6%, respectively. CONCLUSIONS: Our results suggest that hysteroscopy is valuable as a diagnostic tool for malignant/hyperplastic and benign lesions, except for submucous myomas, for which the sensitivity was only 52.6%.

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Section: Introductionmentioning

confidence: 89%

Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women

et al. 2007

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“…9 Many authors suggested that almost 100% accuracy for detection of endometrial cancer by using TVS. 10 While D&C used to be gold standard diagnostic procedure for PMB, several authors on the basis of many well-documented studies considered hysteroscopy as the gold standard investigation because of high quality visualization of focal lesions in uterine cavity. 11,12 PMB in most cases has been reported as gynecological origin, nonetheless non-gynecological causes particularly urological pathologies also must be considered.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Bladder Carcinoma in a Woman Presenting with Postmenopausal Bleeding: Case Report

Akdemir¹,

Zeybek²,

Taylan³

et al. 2015

Turkiye Klinikleri J Gynecol Obst

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ostmenopausal bleeding (PMB) is defined as any uterine bleeding in a menopausal woman except women who are on sequential postmenopausal hormone therapy. This clinical manifestation occurs in approximately 4 to 11 percent of postmenopausal women. [1][2][3][4] Besides, it accounts for about 5 percent of office gynecology visits. 5The main purpose of the investigation in this situation is to rule out malignancy, because 95% of women with endometrial cancer present with PMB as the sole discomfort. 5,6 However, it is not vice versa as the prevalence of endometrial carcinoma is varying from 3-10% in women who experienced PMB. 5,6 In differential diagnosis vaginal and endometrial atrophy, endometrial polyps and carcino- ABSTRACT Although the most common etiology for postmenopausal bleeding is from genital organs, rarely various lesions from adjacent tissues such as urinary tract or distal gastrointestinal tract may cause similar symptomatology that mimics postmenopausal bleeding. We report a case of patient, which was initially evaluated as postmenopausal bleeding through consecutive diagnostic procedures, and finally hysteroscopy and co-existent cystoscopy that revealed in situ bladder carcinoma. When evaluating postmenopausal bleeding especially in elderly women, bladder tumor should be kept in mind while establishing differential diagnosis, and in addition to transvaginal ultrasonography and hysteroscopy, cystoscopy should be performed for further investigation particularly in patients with recurrent postmenopausal bleeding in the absence of gynecological pathology.Key Words: Urinary bladder neoplasms; uterine hemorrhage; postmenopause ÖZET Postmenopozal kanamanın etyolojisinde en sık genital organlar sorumlu iken, nadiren üri-ner ve distal gastrointestinal kaynaklı faktörler genital kaynaklı postmenapozal kanamayı taklit edebilir. Bu olgu sunumunda, ilk olarak postmenopozal kanama nedeniyle tanısal işlemler yapılan ve histeroskopik değerlendirme eşliğinde sistoskopik incelemede in situ mesane karsinomu saptanan bir hasta sunulmuştur. Postmenopozal kanama ile başvuran özellikle ileri yaş hastalarda ayırıcı tanıda mesane kaynaklı tümörler mutlaka akılda bulundurulmalı ve standart tanısal işlemler olan ultrasonografi ve histeroskopiye ek olarak jinekolojik patoloji saptanmadığı takdirde sistoskopi yapılmalıdır.

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“…Endometrial thickness of normal atrophic uterus of a postmenopausal woman does not exceed 4-5 mm. [11][12][13] . Endometrial thickness of <4mm correlated with atrophic endometrium in 289 patents with post menopausal bleeding in a study by Guner et al 14 74.8% of patients had a positive predictive result, 25.2% had endometrial thickness of 6.1±3.7mm but tissue was insufficient for diagnosis and concluded that a cut off value of <4mm for endometrial thickness had a negative predictive accuracy of 100%14.…”

Section: Introductionmentioning

confidence: 99%

Role of transvaginal ultrasound in assessment of endometrial pathology in patients with post-menopausal bleeding

Menon

Sreekumari

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Post-menopausal bleeding (PMB) is the most distressing problem in females Endometrial thickness (EMT) as assessed by transvaginal ultrasound (TVS) aids in diagnosing endometrial pathology. This study analyses usefulness of TVS as a diagnostic tool in the evaluation of PMB.Methods: A prospective study was conducted in 100 patients. Correlation of EMT by TVS was compared with gold standard of histopathological examination (HPE) of the endometrium by fractional curettage (FC).Results: Mean age was 56.9±8.03 years and mean parity status was 2.83±1.45. Mean duration after menopause to presentation of bleeding per vaginum was 5.7±3.85 years. As per the receiver operating characteristic curve (ROC) analysis, an EMT of 10.8 mm had a high negative predictive value (99.1%) for malignancy with moderate specificity (62.79%) and high sensitivity (92.3%).Conclusions: TVS can be easily performed and is less expensive and a useful diagnostic tool in the evaluation of PMB with a cut off value of 10.8 mm EMT gives a high sensitivity (92.3%) and moderate specificity (62.79%).

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Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding

Cited by 269 publications

References 3 publications

Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women

Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women

Diagnosis of Bladder Carcinoma in a Woman Presenting with Postmenopausal Bleeding: Case Report

Role of transvaginal ultrasound in assessment of endometrial pathology in patients with post-menopausal bleeding

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