Comparative Study of Transvaginal Hysterosonography and Biopsy for the Evaluation of Post-Menopausal Bleeding

Abstract

Background:The aim of this prospective study was to evaluate transvaginal hysterosonography (TVHS) in postmenopausal bleeding (PMB) as an alternative to endometrial biopsy. The study was conducted at the Zarka Military Hospital, Amman, Jordan, over a one-year period from 1996 to 1997. Patients and Methods:The study comprised 98 women presenting with post-menopausal bleeding who had been listed for diagnostic dilatation and curettage. Transvaginal sonography (TVS) and transvaginal hysterosonography were performed one week before operation. The mean age of the women was 57 years, and all of them had had their menopause for at least six months. Results: Sixty-one women (62%) demonstrated endometrial thickness of more than 5 mm by transvaginal sonography. All the women had transvaginal hysterosonography, except seven on whom hysterosonography could not be performed for technical reasons and who had to be excluded from the study, leaving a total of 54 women. TVS confirmed the presence of endoluminal mass in 30 of 54 women (60%). Twenty-two of the 30 endoluminal mass cases were pedunculated while eight were sessile. Sixteen of the pedunculated cases were endometrial polyps while the remaining six were fibroid polyps. Five of the sessile cases were fibroid, two were endometrial hyperplasia, and the last one endometrial carcinoma. The other 44 out of the 98 patients also underwent transvaginal hysterosonography. No pathology could be detected in these patients, but they were noted to have atrophic endometrium after dilatation and curettage. Conclusion: The combination of transvaginal sonography and transvaginal hysterosonography is both sensitive and specific with regard to detecting and excluding endoluminal masses as the cause of post-menopausal bleeding. Diagnostic dilatation and curettage fails to detect a large percentage of some lesions, so TVS in combination with TVHS should be considered as the initial examination in the evaluation of all women with post-menopausal bleeding.

Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta‐analysis

“…Another 30 articles were obtained from scanning the reference lists of known primary and review articles in our personal files. After reviewing the full manuscripts of 145 articles, 36 English (3–6,11,14, 33–62), seven German (63–69), four Italian (70–73), two French (74,75), two Chinese (76,77), two Bulgarian (78,79), one Spanish (80), one Polish (81), one Turkish (82), and one Dutch (83) article were selected for inclusion in the overview. There were six articles in which the two reviewers initially disagreed on eligibility but this was resolved easily by consensus.…”

Saline Infusion Sonography in Assessment of Endometrial Pathologies in Patients With Thickened Endometrium Presenting With Aub

“…(2)(3) Transvaginal Sonography (TVS) plays an important role as the initial modality for evaluation of AUB. (1)(2)(3)(4)(5) , but its ability for screening the lesions within the endometrial cavity is limited.…”

“…Focal lesions are underdiagnosed at TVS, because of limitations of the doublelayer thickness evaluation. (3)(4)(5) Transvaginal ultrasound is used conventionally as initial investigation of patients with abnormal uterine bleeding, but saline infusion sonography is a better technique to reliably distinguish focal intracavitary lesion from diffuse endometrial lesions. (2) Transvaginal sonography with saline infusion in patients with AUB has been proved valuable to assess the organic cause for bleeding and is also easily acceptable.…”

“…It is an accurate method for diagnosing endometrial abnormalities with high sensitivity and specificity rates. (4) Saline Infusion Sonography (SIS) is an easy technique in which the endometrial cavity is distended with saline during transvaginal ultrasonic examination and it permits single layer evaluation of the endometrial lining and enables the sonologist to reliably distinguish focal from diffuse endometrial pathologic conditions. Several studies in recent literature have indicated that saline infusion sonography can differentiate intracavitary masses from more diffuse endometrial thickening.…”

Συγκριτική Μελέτη Απεικονιστικού Και Κυτταρολογικού Ελέγχου Του Ενδομητρίου Στην Περιεμμηνόπαυση

“…Διαχωρίζονται αδρά στα «αθώα» αίτια που οφείλονται σε λειτουργικές διαταραχές του ενδομητρίου και σε σοβαρότερα οργανικά αίτια μεταξύ των οποίων και ο καρκίνος του ενδομητρίου. Σύμφωνα με μελέτες, υπολογίζεται ότι στο 5-15% των γυναικών με συμπτώματα περιεμμηνοπαυσικής κολπικής αιμόρροιας το αίτιο που υποκρύπτεται είναι ο καρκίνος του ενδομητρίου 72 . Παράλληλα αναφέρεται ότι ο κίνδυνος παθολογικού ενδομητρίου συσχετίζεται σημαντικά με την αύξηση του πάχους του ενδομητρίου, όπως υπολογίζεται βάσει του ενδοκολπικού υπερηχογραφήματος.…”