A randomised controlled trial comparing transvaginal ultrasound, outpatient hysteroscopy and endometrial biopsy with inpatient hysteroscopy and curettage

Abstract

Objective To compare the use of outpatient and inpatient procedures in the investigation of abnormal Design A randomised controlled trial.Setting Two university teaching hospitals.Participants Four hundred women with abnormal uterine bleeding (postmenopausal bleeding, menorrhagia, intermenstrual bleeding, postcoital bleeding, or irregular periods) above the age of 35 years, between June 1993 and January 1995.1. Incidence of detection of abnormal pathology by vaginal ultrasound, outpatient hysteroscopy and endometrial biopsy compared with inpatient hysteroscopy and curettage; 2. Number of 'lesions' (e.g. fibroids, polyps, endometrial hyperplasia or malignancy) found by hysteroscopy that would have been missed by the combination of endometrial sampling and ultrasound; 3. Comparison of the quality of tissue obtained for histology by outpatient endometrial sampling and inpatient curettage; and 4. An evaluation of patient acceptability of outpatient and inpatient procedures.

Hysteroscopy in Evaluation of Abnormal Uterine Bleeding

“…Shwarzler [2] studied a total of 104 patients with age varying from 26 to 79 years. Tahir [3] studied 400 women all above age of 35 years. Giannninoto [4] performed diagnostic hysteroscopy in 512 women with complaints of AUB, age ranging from 38 to 80 years and with mean age of 63 years.…”

Investigation of Women with Postmenopausal Uterine Bleeding: Clinical Practice Recommendations

“…This increased risk is almost, if not totally, eliminated if appropriate cyclic or continuous progestins are added to the regimen 17 (Class 4), 23 (Class 1a), 24 (Class 1b). However, a number of features may affect these risks, including the dose of the estrogen, and the dose, route, and regimen used to administer the progestin.…”

“…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.…”

“…Hysteroscopy has good diagnostic accuracy for structural lesions, such as polyps and leiomyomas, whether or not performed in an office setting, and good patient acceptability in either setting 24,86 (Class 1b). Indeed, in a study designed to determine the desires of women regarding a primary assessment tool for evaluation of postmenopausal bleeding, 95% preferred to undergo office hysterectomy rather than experience a 5% chance that a lesion could be missed 87 (Class 6).…”

Acute Uterine Bleeding Unrelated to Pregnancy: A Southern California Permanente Medical Group Practice Guideline

“…Office endometrial sampling with narrow disposable catheters has been generally demonstrated to be equivalent to the so-called "formal" dilation and curettage for diagnosing endometrial carcinoma. [38][39][40] …”