Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding — a Nordic multicenter study

Karlsson, Bengt; Granberg, S.; Wikland, Matts; Ylöstalo, Pekka; Kiserud, Torvid; Maršál, Karel; Valentin, Lil

doi:10.1016/0002-9378(95)90483-2

Cited by 494 publications

(163 citation statements)

References 21 publications

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“…In previous studies endometrial thickness ≤4–5 mm has consistently been shown to be highly associated with a lack of significant endometrial pathology and has been suggested to be a reliable tool to exclude type 1 endometrial carcinoma [11,12,13]. However, this is not necessarily the case for type 2 uterine malignancies.…”

Section: Discussionmentioning

confidence: 76%

Abnormal Cervical Cytology in the Diagnosis of Uterine Papillary Serous Carcinoma: Earlier Detection of a Poor Prognostic Cancer Subtype

et al. 2011

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Objective: Early detection of uterine papillary serous (UPSC), clear cell (CCC), and grade 3 endometrioid carcinomas (G3EC) – all poor prognostic variants of endometrial carcinoma (EC) – is of particular clinical relevance. The study objective was to assess the utility of liquid-based cytology (Pap) in the detection of high-grade EC. Study Design: A retrospective, two-institution analysis of patients diagnosed with UPSC, CCC, or G3EC with a preoperative Pap from 1999 to 2010 was conducted. Results: One hundred and one patients were evaluated; 51.5% had UPSC, 27.7% had CCC, and 20.8% had G3EC. Stage I/II disease was found in 69.3% of patients, and 46/101 patients (45.5%) had abnormal Paps. Significantly more patients with UPSC had abnormal Paps (65.7%) than those with CCC (25%) or G3EC (23.8%; p < 0.001). An abnormal Pap was the only presenting clinical finding in a significant number of asymptomatic UPSC patients (26.9%) compared with 4% of patients with CCC and G3EC (p = 0.005). On multivariate analysis, UPSC histology was the only variable associated with an abnormal Pap. Conclusions: A high incidence of abnormal cervical cytology was observed in women with high-grade EC, particularly in UPSC patients. Although hypothesis generating, a proportion of asymptomatic UPSC patients had abnormal cytology, signifying that Pap smear screening may help detect the disease before the patient develops symptoms.

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Section: Discussionmentioning

confidence: 76%

Abnormal Cervical Cytology in the Diagnosis of Uterine Papillary Serous Carcinoma: Earlier Detection of a Poor Prognostic Cancer Subtype

et al. 2011

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“…As a result, evaluation with ultrasound, Doppler, or HSG is only ancillary to a definitive biopsy either in the office or in the operating room [33][34][35][36]. However, TVS demonstration of an endometrial thickness of 4 mm or less virtually excludes carcinoma with the same reliability as an EMB plus D&C. When TVS demonstrates a thin endometrium and the question asked is strictly related to presence or absence of cancer, biopsy is not necessary; in the Nordic Trial, the number of biopsies was decreased by 46% without loss of accuracy [28]. If an EMB is inadequate, as happens frequently, TVS with or without HSG can be used to determine if the inadequate tissue sample is due to endometrial atrophy or to a technical failure requiring further evaluation with D&C and hysteroscopy.…”

Section: Postmenopausal Bleedingmentioning

confidence: 92%

“…12). However, in the multicenter ''Nordic Trial,'' 35% of women with PMB with endometrial thicknesses of 6-10 mm had atrophic endometria histologically [28] (Figs. 3, 7).…”

Section: Postmenopausal Bleedingmentioning

confidence: 96%

Ultrasound of the endometrium: facts, controversies, and future trends

Bree

1997

Abdom Imaging

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“…Asymptomatic postmenopausal women with a thickened endometrium found by ultrasound are also subjected to hysteroscopy, since the diagnostic value of endometrial thickness has not yet been documented [6,9]. However, ultrasound is a valuable tool for evaluating patients with postmenopausal bleeding [9,10,11,12]…”

Section: Introductionmentioning

confidence: 99%

Hysteroscopy as a Valid Tool for Endometrial Pathology in Patients with Postmenopausal Bleeding or Asymptomatic Patients with a Thickened Endometrium: Hysteroscopic and Histological Results

Loiacono

Trojano

Gaudio

et al. 2015

Gynecol Obstet Invest

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Objective: This study compares hysteroscopic and histopathological results in postmenopausal women with abnormal uterine bleeding (AUB) and asymptomatic postmenopausal women with a thickened endometrium. Materials and Methods: This is a retrospective study of 570 cases hysteroscopically examined between January 2008 and July 2012. The patients were followed up at the Istituto Tumori ‘Giovanni Paolo II', Bari, Italy. Results: A total of 320 of the 570 cases were selected. The inclusion criteria were transvaginal ultrasound, hysteroscopy and endometrial biopsy. In the AUB group, if the hysteroscopy results were normal, a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100, 95, 71 and 100%, respectively, were achieved, while in the asymptomatic group these values were 100, 97, 90 and 100%, respectively. For both the group with polyps and that with myomas, the sensitivity, specificity, PPV and NPV were 100%. For endometrial hyperplasia, hysteroscopy showed a sensitivity, specificity, PPV and NPV of 81, 96, 87 and 93%, respectively, in the AUB group, while in the asymptomatic group, the sensitivity was 60%, the specificity and PPV were 100%, and the NPV was 98%. The sensitivity of hysteroscopy for endometrial cancer was 63%, the specificity 97%, the PPV 77%, and the NPV 95%. Conclusions: In postmenopausal women with a thickened endometrium with or without AUB, hysteroscopy allows for an accurate diagnosis in benign endometrial pathology. Hysteroscopy also allows directed biopsies of suspicious lesions, which is useful in malignant endometrial pathology.

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Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding — a Nordic multicenter study

Cited by 494 publications

References 21 publications

Abnormal Cervical Cytology in the Diagnosis of Uterine Papillary Serous Carcinoma: Earlier Detection of a Poor Prognostic Cancer Subtype

Abnormal Cervical Cytology in the Diagnosis of Uterine Papillary Serous Carcinoma: Earlier Detection of a Poor Prognostic Cancer Subtype

Ultrasound of the endometrium: facts, controversies, and future trends

Hysteroscopy as a Valid Tool for Endometrial Pathology in Patients with Postmenopausal Bleeding or Asymptomatic Patients with a Thickened Endometrium: Hysteroscopic and Histological Results

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