Vaginal ultrasonography in patients with postmenopausal bleeding

Abstract

Our objective was to define a subset of women with postmenopausal bleeding in whom the accepted practice of endometrial sampling could be safely omitted. Vaginal endosonographic measurements were compared to the histological findings of curettings following diagnostic dilatation and curettage in 129 women with post-menopausal bleeding who were not receiving hormonal therapy. Atrophy was diagnosed in 49%, slight proliferation in 10%, endometrial polyps in 11%, hypoplasia in 12%, and adenocarcinoma in 12%. Endometrial atrophy was associated with a mean sonographic thickness of 2.6 mm of the double layer (range 0-6.5 mm). Of the women with a final histological diagnosis of atrophy, 92% had an endometrial thickness of 3 mm or less. Furthermore, all women with a sonographic endometrial thickness of 3 mm or less had atrophic endometrium (p < 0.0001). An endometrial thickness of 3 mm or less would have reduced the number of dilation and curettage procedures by 45% and no cases of endometrial pathologies would have been missed. In women presenting with postmenstrual bleeding, meticulous scanning of the endometrium can select a group where endometrial sampling can be omitted from the protocol.

Clinical evaluation of women with PMB. Is it always necessary an endometrial biopsy to be performed? A review of the literature

“…A specificity of 81% and a sensitivity of 97% in diagnosing morphological alterations by means of TVUS were found. Moreover, other authors [11] determine the sensitivity and specificity for the measurement of endometrial thickness using TVUS to diagnose an endometrial abnormality at 100 and 75%, respectively. The corresponding figures for hysteroscopy were 97 and 88%.…”

Endovaginal Ultrasound to Exclude Endometrial Cancer and Other Endometrial Abnormalities

“…Additional nonpublished results were obtained from 2 authors, and these are included in our analysis with published results by the same authors. 20,61 For studies that resulted in multiple publications, data from the most recent publication were used.…”

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

“…In the past, diagnostic tests such as EMB, D&C, hysteroscopy, and even hysterectomy were used to allay the fear of cancer. Even though endometrial atrophy is the most common cause of PMB and cancer is only seen in about 10% of patients with PMB, defining the absence of significant pathology is important in this patient population [26]. Finding less significant but treatable abnormalities, such as an endometrial polyp, is important for the psychological health of the patient.…”