Transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding: a prospective study

Abstract

Objective. To determine the diagnostic value of transvaginal ultrasonography and hysteroscopy in patients with postmenopausal bleeding. Material and methods. Between January 1, 1998 and June 30, 1999, 88 outpatient women with postmenopausal bleeding were enrolled in a prospective study. They underwent transvaginal ultrasonography and hysteroscopy, and were submitted to directed biopsy during hysteroscopy. Findings were classified as normal endometrium, suggestive of atrophy, focal abnormality (benign or suspicious), and diffuse thickness (benign or suspicious). Data was compared with the final diagnosis, established by histological examination, as atrophy, benign pathology, atypical hyperplasia and endometrial carcinoma. Results. Among 88 women enrolled, 15 were excluded because hysteroscopy was impossible, and four had abandoned the study. The histological findings were scanty material in 12 (17.4%), atrophy in 24 (34.8%), cystic atrophy in one (1.4%), normal endometrium in five (7.2%), tuberculous endometritis in one (1.4%), polyps in 12 (17.4%), leiomyoma in one (1.4%), non-atypical hyperplasia in three (4.3%), atypical hyperplasia in one (1.4%) and endometrial carcinoma in nine cases (13.0%). For the assessment of endometrial carcinoma, ultrasonography revealed sensitivity 77.8%, specificity 93.3%, positive predictive value 63.6%, negative predictive value 96.6%; and hysteroscopy revealed sensitivity of 88.9%, specificity 98.3%, positive predictive value 88.9%, negative predictive value 98.3%. The combined use of both methods revealed sensitivity 100%, specificity 91.7%, positive predictive value 64.3%, negative predictive value 100%. Conclusions. Both imagiological methods were found to be useful screening tests for endometrial carcinoma. Hysteroscopy was a superior diagnostic procedure.

Comparison of Transvaginal Ultrasonography and Hysteroscopy in the Evaluation of Peri and Postmenopausal Bleeding

“…This gave sensitivity of 100%, specificity of 100%, positive predictive value of 100% and negative predictive value of 100% in diagnosing endometrial cancer. This correlates with the study done by Rita Souse et al 12 Haller H et al 13 and Pekka Taipale et al 14 Since we had only one case of which was found to have cancer endometrium, much statistical importance cannot be given to this.…”

Diagnostic hysteroscopy and the risk of malignant cells intraabdominal spread in women with endometrial cancer

“…The method is often used in the evaluation of women with infertility and/or abnormal uterine bleeding [11]. Hysteroscopy has high sensitivity of 67-96% and specificity in the detection of endometrial cancer [12][13][14]. Collection of material with the use of hysteroscopy is more precise in cancer diagnostics compared to fractional dilatation and curettage of uterine cavity [13].…”

Vídeo-histeroscopia da imagem endometrial alterada: uma avaliação crítica

“…Nesta base de dados observou-se um contínuo aumento das solicitações dos exames com base na ultra-sonografia alterada no endométrio A histeroscospia apresenta alta acurácia diagnóstica nos casos de câncer de endométrio 13 e combinada com a biópsia é citada como "padrão-ouro" no diagnóstico de cân-cer de endométrio, com 100% de sensibilidade 14 . Souza et al 15 em 88 histeroscopias, tiveram nove casos de câncer (13%), com níveis de sensibilidade de 88,9%, especificidade de 98,3%, valor preditivo positivo de 88,9% e valor preditivo negativo de 98,3%.…”