Open-access transvaginal sonography in women of reproductive age with abnormal vaginal bleeding: a descriptive study in general practice

Abstract

BackgroundDiagnostic ultrasonography is used by GPs in approximately 10% of patients of reproductive age with abnormal vaginal bleeding. Transvaginal sonography is recommended as a first-line diagnostic instrument for assessing uterine pathology. AimTo assess if findings resulting from openaccess sonography were in agreement with the GPs' working hypotheses and if these findings contributed to GPs' management. Design and settingProspective observational cohort study of GPs working in the health district of the Academic Medical Center, Amsterdam and their patients consulting with abnormal vaginal bleeding. MethodData on patients' history, GPs' primary working hypotheses, and intended management were recorded. After sonography, GPs recorded their actual management. ResultsA total of 122 patients were included by 18 GPs from June 2003 to December 2004. Data from 89 patients were available for analysis. The GPs' working hypotheses implied 'no structural pathology' in 65/89 patients, and 'fibroids' in 24/89 patients. Sonographic findings were confirmed in 50/65 patients where 'no structural pathology', and in 14/24 of those where 'fibroids' were expected. Initially, GPs had intended to refer nine patients to a gynaecologist. Actual management after sonographic assessment was watchful waiting or drug therapy in 57/89 patients. Eighty-nine per cent of these patients had normal sonographic findings. The actual referral rate rose to 27/89 patients. In 17 referred patients, sonographic findings were suggestive of intracavitary abnormalities. ConclusionOpen-access sonography contributed to more accurate diagnoses and improved GPs' management of women with abnormal vaginal bleeding.

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

“…Gastroscopy was the most commonly studied DA test (27 studies), followed by lower GI endoscopy (proctoscopy, flexible sigmoidoscopy, or colonoscopy, 15 studies), [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] CT (three studies -two head, one chest), [65][66][67] ultrasound (three studiestwo abdominal, one gynaecological), [68][69][70] MRI (three studies), [71][72][73] X-ray (two studies), 74,75 gastroscopy and lower endoscopy combined (two studies), 76,77 mammogram (one study), 78 mammogram and ultrasound combined (one study), 79 MRI and CT combined (one study), 80,81 transvaginal sonography (one study), 82 and a range of radiological tests including MRI, CT, and barium meal (one study). 83 Fifty-seven studies (95%) reported DA testing performed in a hospital or specialist clinic setting, one utilised a DA test located in primary care, 28 and two did not specify location.…”

“…Across the remaining 14 studies reporting data to allow the calculation of cancer and other diagnoses CR, the cancer CR ranged from 0.0% for transvaginal sonography for abnormal vaginal bleeding to 11.7% in a study reporting a wide range of DA tests used at the GPs' discretion. 82,83 The conversion rate for non-cancer diagnosis ranged from 4.2% for patients undergoing mammogram to 56.4% in a study reporting the use of DA X-ray used at GPs' discretion. 75,78 (Further information is available from the authors on request.)…”

Comparison between 2D sonohysterography, 3D sonohysterography, and diagnostic hysteroscopy for assessment of intrauterine lesions in premenopausal bleeding patients and their correlation with the histopathology

“…Abnormal uterine bleeding is a common problem that accounts for up to 30% of outpatient visits to gynecologists [1][2][3]. In premenopausal women, it is the single most common reason for gynecological referrals.…”