Ultrasound, hysteroscopy and endometrial biopsy in the investigation of endometrial cancer

Avaliação de morfologia e histologia endometrial de mulheres após a menopausa

“…However, it has low sensitivity and specificity for post-menopausal endometrial abnormalities and cannot provide an etiologic diagnosis for any lesions found. 2 Uterine curettage, which was the established gold standard for a long time, is no longer recommended as first choice for screening of endometrial cancer, 5 because its successor, diagnostic hysteroscopy with guided biopsy, 3,4 offers high sensitivity and specificity, few contraindications or complications and lower cost, since it can be conducted in an ambulatory setting. 6 Transvaginal ultrasonography, another possibility for screening and diagnosis of endometrial abnormalities, does not alone improve on the results achieved with hysteroscopy and biopsy, but when combined with hysteroscopy and biopsy, it makes endometrial assessment much more precise.…”

“…6 Transvaginal ultrasonography, another possibility for screening and diagnosis of endometrial abnormalities, does not alone improve on the results achieved with hysteroscopy and biopsy, but when combined with hysteroscopy and biopsy, it makes endometrial assessment much more precise. 5 Although ultrasonography is a fast, low-cost and noninvasive test, it suffers from certain technical limitations that are operator-dependent. 5,7,8 Indeed, even when the observers are experienced, when endometrial thickness is measured twice, by the same observer or by two different observers, variations are observed of 0.8mm and 1.0mm respectively, with precision errors of less than 0.7mm.…”

“…5 Although ultrasonography is a fast, low-cost and noninvasive test, it suffers from certain technical limitations that are operator-dependent. 5,7,8 Indeed, even when the observers are experienced, when endometrial thickness is measured twice, by the same observer or by two different observers, variations are observed of 0.8mm and 1.0mm respectively, with precision errors of less than 0.7mm. 7 observed that with women whose endometrial thickness is close to 5mm, the maximum intraobserver difference was 2mm.…”

“…As a result, 50% of postmenopausal women subjected to transvaginal ultrasound for screening of endometrial cancer needed hysteroscopy for a full diagnosis. 5 Therefore, when compared with diagnostic hysteroscopy, transvaginal ultrasound offers little accuracy and poor specificity for endometrial disorders. 10,11 Studies that have assessed the endometrium of postmenopausal women using hysteroscopy investigated women on hormone therapy or with vaginal bleeding and/or endometrial thickening on ultrasound.…”

Eficiencia De Los Métodos Diagnósticos en El Estudio Del Sangrado Uterino Anormal en La Peri Y Postmenopausia

“…En pacientes postmenopáusicas, es particularmente importante debido a que puede significar la presencia de cán-cer endometrial, siendo el principal síntoma en el 75 a 90% de las pacientes que sufren esa enfermedad. Más importante aún, 5 a 10% de todas las pacientes postmenopáusicas con sangrado uterino anormal tienen cáncer endometrial, y esta cifra podría alcanzar el 60% en las pacientes de 80 años (1).…”