Hysteroscopy and transvaginal ultrasonography in postmenopausal women with uterine bleeding

Garuti, Giancarlo; Sambruni, Ivan; Cellani, Fulvia; Garzia, Delia; Alleva, P; Luerti, Massimo

doi:10.1016/s0020-7292(98)00224-0

Cited by 60 publications

(52 citation statements)

References 20 publications

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“…In present study, the sensitivity and specificity of TVS for suspecting endometrial pathology at ET B 4 mm were 87.09 and 75.86 %, respectively. Similar studies conducted by different investigators, Karlsson et al [2], Gull et al [3], Garuti et al [4] , Tinelli et al [5], and Kaur et al [6], had shown the sensitivity ranging from 89 to 100 % while specificity from 54.8 to 86 % at ET of 4 mm. In the present study, sensitivity, specificity, PPV, and NPV for Total 60 100…”

Section: Discussionsupporting

confidence: 64%

Correlation of Endometrial Thickness with the Histopathological Pattern of Endometrium in Postmenopausal Bleeding

Singh

Dwivedi

Mendiratta

2014

J Obstet Gynecol India

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Background Menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Bleeding that occurs 12 months after the last menstrual period is labeled as postmenopausal bleeding. Aims & objectives The aim of the present study was to study endometrial thickness by transvaginal sonography, and correlate it with the cytological pattern evaluated by endometrial aspiration and histopathological pattern of the hysteroscopic directed biopsy. Results Sixty patients presenting with postmenopausal bleeding in outpatient department, after applying both inclusion and exclusion criteria, were enrolled in the present study. Majority (38.33 %) of patients had atrophic endometrium or normal endometrium. Endometrium was hyperplastic in 18 (30 %) patients, polyp in 6 (10 %) patients, and growth in 7 (11.67 %) patients. On histopathology, majority of patients (38.33 %) had atrophic endometrium. Endometrial hyperplasia was detected in 14 (23.33 %) out of which 11 had simple hyperplasia while 3 had atypical hyperplasia. Endometrial cancer was detected in 8 (13.33 %) patients. Out of 8 cases of endometrial malignancy, one case was confirmed as endometrial adenocarcinoma on histopathology. Conclusion Role of endometrial thickness cannot be undermined for detecting patients at high risk especially with comorbid conditions. Histo-pathological evaluation is mandatory for ruling out malignancy in selected cases of PMB through hysteroscopy.

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Section: Discussionsupporting

confidence: 64%

Correlation of Endometrial Thickness with the Histopathological Pattern of Endometrium in Postmenopausal Bleeding

Singh

Dwivedi

Mendiratta

2014

J Obstet Gynecol India

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“…Currently, there is abundant scientific evidence (Garuti et al 1999, Bronz 2000, Litta et al 2005, Guruwadayarhalli et al 2007, Tinelli et al 2008) that hysteroscopic examination is the gold standard for the management of AUB, with curettage of the uterine cavity required only for the treatment of haemostatic urgencies and when active bleeding is present.…”

Section: Discussionmentioning

confidence: 99%

“…On this basis, office hysteroscopy could be considered a safe, well-tolerated diagnostic test that enables targeted endometrial biopsies because it accurately distinguishes normal endometrium from pathologic endometrium and has a better sensitivity, specificity, PPV and NPV than ultrasound (Garuti et al 1999, Taponeco et al 2002, Tinelli et al 2008.…”

Section: Discussionmentioning

confidence: 99%

Endometrial surveillance in tamoxifen users: role, timing and accuracy of hysteroscopic investigation: observational longitudinal cohort study

Saccardi¹,

Gizzo²,

Patrelli³

et al. 2013

Endocrine-Related Cancer

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To determine the role, timing and indications for endometrial hysteroscopic investigation in relation to the clinical, ultrasound and histological features of the endometrium during tamoxifen (TAM) use. We performed an observational longitudinal cohort study (years 2007-2012) that investigated the endometria of 151 TAM users with hysteroscopy and histology. For all patients, gynaecological history, years of adjuvant treatment, ultrasound endometrial thickness measurement and indications for hysteroscopy were recorded. Hysteroscopic findings showed that 100% of patients referred for simple follow-up had no evidence of endometrial disease. We found a strong correlation between previous history of abnormal uterine bleeding (with or without endometrial thickening) and hysteroscopic suspicion of endometrial atypia that was confirmed by histology. Hysteroscopy had 83.3% sensitivity, 99% specificity, 83.3% positive predictive value (PPV) and 99% negative predictive value (NPV) in detecting endometrial atypia. No significant correlation was found between endometrial thickening to O5 mm without bleeding and histological atypia. Similarly, the duration of treatment was not related to endometrial thickening and histological atypia. Endometrial stromal hyperplasia was detected by histology in 70.5% of patients with endometrial thickness measurements ranging from 5 to 10 mm. In contrast, no atypia was detected when endometrial thickness was !5 mm. Ultrasound performed using a 5-mm cut-off threshold for endometrial thickness resulted in 100% sensitivity, 15% specificity, 4% PPV and 100% NPV in detecting endometrial atypia, while a 10-mm cut-off threshold resulted in 84% sensitivity, 69% specificity, 10% PPV and 99% NPV. Low-risk TAM users do not require different endometrial surveillance than the general population. Hysteroscopy could play a fundamental role in determining the endometrial status of patients before the initiation of TAM treatment and in assessing the endometrial status of patients when bleeding occurs.

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“…Office-based sampling is usually performed with disposable catheters that allow for the application of suction to obtain a specimen. Any method of sampling the endometrial cavity misses a proportion of endometrial cancers 24 (Class 1b), 47,48 (Class 3), 49 Collectively, these data would suggest that women with "nondiagnostic" endometrial biopsy specimens should have additional uterine evaluations with TVUS, contrast sonography, hysteroscopy, or a combination of any of these procedures.…”

Section: Histologic Assessmentmentioning

confidence: 99%

Investigation of Women with Postmenopausal Uterine Bleeding: Clinical Practice Recommendations

Munro

2014

TPJ

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Hysteroscopy and transvaginal ultrasonography in postmenopausal women with uterine bleeding

Cited by 60 publications

References 20 publications

Correlation of Endometrial Thickness with the Histopathological Pattern of Endometrium in Postmenopausal Bleeding

Correlation of Endometrial Thickness with the Histopathological Pattern of Endometrium in Postmenopausal Bleeding

Endometrial surveillance in tamoxifen users: role, timing and accuracy of hysteroscopic investigation: observational longitudinal cohort study

Investigation of Women with Postmenopausal Uterine Bleeding: Clinical Practice Recommendations

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