Improving the existing diagnostic strategy by accounting for characteristics of the women in the diagnostic work up for postmenopausal bleeding

Opmeer, Brent C.; Doorn, Helena C. van; Heintz, A. Peter M.; Burger, Curt W.; Bossuyt, P. M. M.; Mol, Ben Willem J.

doi:10.1111/j.1471-0528.2006.01168.x

Cited by 41 publications

(55 citation statements)

References 15 publications

(26 reference statements)

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“…Risk of endometrial cancer in women with PMB rises with age, peak incidence was observed in the age group of 55-70 yrs which was similar to those observed by Opmeer et al and Kothapally K et al 17,18 All the patients except those with frank ca cervix underwent dilatation and curettage. Table 3 shows the different histopathological findings on fractional curettage among benign aetiology, atrophic endometritis was most common followed by functional endometrium.…”

Section: Resultssupporting

confidence: 85%

A study of aetiology and prevalence of malignancy in patients with post menopausal bleeding

Sharma¹,

Chandnani²

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONWHO has defined menopause as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity.1 Postmenopausal bleeding (PMB) is defined as abnormal uterine bleeding occurring after one year of menopause. Common menopausal age in Indian women is around 42-50 years. It is a common clinical problem, occuring in approximately 3%-5% of post menopausal women and represents one of the most common reasons for referral to gynaecological services, largely due to suspicion of an underlying genital tract malignancy.2,3 Aetiology of post menopausal bleeding includes benign causes like proliferative or atrophic ABSTRACT Background: Post-menopausal bleeding (PMB) is a frequent and alarming sign and exclusion of genital tract malignancy should be the primary aim of investigation. Approximately 1 in 10 women experiences this problem. Increasing time interval between menopause and onset of post-menopausal bleeding is highly indicative of malignancy. Objectives of this study were to study the various etiologies and risk factors of post-menopausal bleeding and to find the prevalence of malignant pathology in women with post-menopausal bleeding. Methods: Prospective observational study carried out in Obstetrics and Gynecology department of SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, comprising of 150 consecutive cases of postmenopausal bleeding occurring after one year of menopause, presenting in OPD or admitted in Gynecology or emergency ward with the same complaint. Patients were assessed clinically as well as thoroughly investigated to find out exact etiology. Pap smears, tranvaginal ultrasound, fractional curettage and biopsies were done. Statistical analysis of data was done after compiling and tabulation of data. Mean±SD for age and percentages for etiologies were calculated and compared with other studies. Results: Benign aetiology was seen in 74% of the cases, malignant aetiology in 24% which is a significant proportion of menopausal women presenting with Post-menopausal bleeding. 58% (87/150) patients were in the age group 50-59 and presented after five to ten years of menopause. Commonest benign aetiology was atrophic endometrium 25.4% and another 32.5% had functional endometrium as cause of PMB (proliferative 13.2%, hyperplasia 13.2% and secretory 6.1%). Among malignancies carcinoma cervix was the commonest, 52.7%, (12.6%) of study population followed by carcinoma endometrium, 25% (6% of total population), thus making thorough and proper evaluation of all cases of PMB mandatory to pick up malignant lesions at early stage and initiate treatment accordingly. Conclusions: Post-menopausal bleeding has become a common complaint in gynecology OPD and considering its possible association with malignancy, even slightest amount of bleeding demands proper work up.

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Section: Resultssupporting

confidence: 85%

A study of aetiology and prevalence of malignancy in patients with post menopausal bleeding

Sharma¹,

Chandnani²

2017

Int J Reprod Contracept Obstet Gynecol

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“…Various methods of endometrial sampling are used in practice, including invasive and non-invasive on an inpatient or outpatient basis (8,9). D&C is an invasive inpatient procedure performed under general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Pipelle endometrial sampling versus conventional dilatation & curettage in patients with abnormal uterine bleeding

Abdelazim

Aboelezz

Abdulkareem

2013

J Turkish German Gynecol Assoc

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Objective: This study was designed to compare the diagnostic accuracy of Pipelle endometrial sampling with conventional dilatation & curettage in patients with abnormal uterine bleeding. Material and Methods:One hundred and forty patients with abnormal uterine bleeding were included in this comparative study; where endometrial sampling was carried out before cervical dilatation by Pipelle device followed by conventional dilatation & curettage (D&C). The histopathology report of the Pipelle sample was compared with that of the dilatation & curettage sample and the dilatation & curettage reports were considered as the gold standard.Results: 100% of the samples obtained by conventional D&C, while 97.9% of the samples obtained by the Pipelle device were adequate for histopathological examination. The histolopathological examination of 140 samples obtained by conventional D&C revealed proliferative endometrium in 37 specimens, secretory endometrium in 33 specimens, endometrial hyperplasia in 49 specimens (45 without atypia & 4 with atypia), endometritis in 8 specimens, endometrial polyps in 3 specimens and malignant endometrium in 10 specimens. In this study; the Pipelle device had 100% sensitivity, 100% specificity and 100% accuracy for diagnosing endometrial hyperplasia, endometrial carcinoma, proliferative and secretory endometrium. Also, it had 88.9% sensitivity, and 99.2% negative predictive value (NPV) and 99.3% accuracy for diagnosing endometritis and it had 60% sensitivity, 89.6% NPV and 98.6% accuracy for diagnosing endometrial polyps. Conclusion:The endometrial sampling using Pipelle is a safe, accurate, cost effective outpatient procedure, which avoids general anesthesia and has a high sensitivity and specificity for detection of endometrial hyperplasia and endometrial malignancy. Received: 06 November, 2012 Accepted: 12 December, 2012 Amaç: Bu çalışma anormal uterin kanaması olan hastalarda Pipelle endometriyal örnek alımının tanısal doğruluğunu geleneksel dilatasyon ve küretaj ile karşılaştırmak üzere tasarlandı. Gereç ve Yöntemler:Bu karşılaştırmalı çalışmaya anormal uterin kanaması olan 140 hasta dâhil edildi; Pipelle aleti ile servikal dilatasyondan önce endometriyal örnek alınmasının ardından geleneksel dilatasyon ve küretaj (D&C) yapıldı. Pipelle örneğinin histopatoloji raporu dilatasyon ve küretaj örneğininki ile karşılaştırıldı ve dilatasyon ve küretaj raporları altın standart olarak kabul edildi. Bulgular:Geleneksel D&C ile alınan örneklerin %100'ü, Pipelle aleti ile alınan örneklerin ise %97.9'u histopatolojik inceleme için yeterliydi. Geleneksel D&C ile alınan 140 örneğin histopatolojik incelemesi 37 örnekte proliferatif endometriyum, 33 örnekte sekretuar endometriyum, 49 örnekte endometriyal hiperplazi (45'inde atipi yok ve 4'ünde atipi var), 8 örnekte endometrit, 3 örnekte endometriyal polip ve 10 örnekte malign endometriyum gösterdi. Bu çalışmada, endometriyal hiperplazi, endometriyal karsinoma, proliferatif ve sekretuar endometriyum tanısında Pipelle aleti; %100 sensitivite, %100 spesi...

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“…However, the use of oral contraceptives reduces the risk. 21,15,11 The mean endometrial thickness in post-menopausal women should not exceed 4mm and 10mm in pre menopausal women.…”

Section: 31mentioning

confidence: 99%

“…24 Transvaginal ultrasonography (TVS) is a first line investigating tool, but some authors have a different theories for the accuracy of TVS to excluding endometrial malignancy. 21 bleeding, still remains controversial. In future the research should be focused to achieving a higher accuracy of different diagnostic strategies.…”

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confidence: 99%

POSTMENOPAUSAL UTERINE BLEEDING; CORRELATION OF THE FINDINGS OF TRANSVAGINAL ULTRASONOGRAPHY & ENDOMETRIAL SAMPLING IN PATIENT

Memon

Munwar²,

Bilquees³

et al. 2016

TPMJ

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ABSTRACT… Objectives: To find out the significance of the transvaginal sonography (TVS) in postmenopausal women (PMW) with postmenopausal bleeding (PMB) and compare it with the histopathological diagnosis at curettage, so that unnecessary operations could be avoided. Study Design: Descriptive study. Setting: Radiological Department for TVS and H/P at the Department of Gynecology & Obstetrics (Gynae: Unit IV) at Liaquat University Medical, Health Sciences Hospital Jamshoro and Hyderabad. Period: September 2010 to September 2011. Material and Methods: The present study was conducted on patients with postmenopausal bleeding. Results: The mean age + SD of the women was 51 + 3.1 years, ranging from a minimum of 49 to 55 years. The mean endometrial thickness was from 1.8-15mm. Transvaginal Sonography and Histopathological Findings: Histopathological findings revealed endometrial atrophy in 64 (57.14%) patients, Endometrial hyperplasia in 24(21.4%), endometrial polyp in 7(6.25%), Endometrial carcinoma in 8 (7.14%), Pyometra in 5(4.46%) and Fibroid uterus in 4(3.57%). With a cut off value of 4mm endometrial thickness, TVS showed a sensitivity of 100%, specificity of 73.33%, a positive predictive value of 76.47%, a negative predictive value 100% and an accuracy of 85.71%. At a cut off limit of 5mm endometrial thickness (endometrium >5mm indicating pathology), the sensitivity of the present study was 92.3% and the specificity was 86.6 %. The positive predictive value was 85.71%, the negative predictive value was 92.86 % and the accuracy was 89 %. Conclusion: TVS is a useful tool to triage post menopausal women with bleeding and avoid un convenient invasive procedure.

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Improving the existing diagnostic strategy by accounting for characteristics of the women in the diagnostic work up for postmenopausal bleeding

Cited by 41 publications

References 15 publications

A study of aetiology and prevalence of malignancy in patients with post menopausal bleeding

A study of aetiology and prevalence of malignancy in patients with post menopausal bleeding

Pipelle endometrial sampling versus conventional dilatation & curettage in patients with abnormal uterine bleeding

POSTMENOPAUSAL UTERINE BLEEDING; CORRELATION OF THE FINDINGS OF TRANSVAGINAL ULTRASONOGRAPHY & ENDOMETRIAL SAMPLING IN PATIENT

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